BACKGROUND:Understanding the characteristics and influencing factors of the gut microbiota in athletes can help determine the optimal gut microbial composition for relevant sport events.Further investigation in this area could provide important insights for improving athletic performance and recovery as well as developing personalized nutrition prescriptions.OBJECTIVE:To summarize the characteristics of gut microbiota in athletes,and to elucidate the important factors influencing the gut microbiota characteristics of athletes from the perspectives of exercise training and dietary intake.METHODS:A literature search was conducted using the PubMed,ScienceDirect,CNKI,WanFang and VIP databases for publications from 2004 to 2024.The search terms included"microbiota,microbiome,athlete,exercise,training,diet,nutrition,dietary fiber,protein,ketogenic,fat"in English and Chinese.After excluding studies of poor quality and irrelevant content,a total of 65 articles were included for review and analysis.RESULTS AND CONCLUSION:(1)The gut microbiota of elite athletes differs from that of the general population,characterized by increased α-diversity,elevated Firmicutes/Bacteroidetes ratio,increased abundance of beneficial bacteria,and enrichment of functional pathways contributing to athletic performance.(2)The type of sport and training load are closely related to the species structure and functional expression of the gut microbiota in athletes.(3)The bidirectional communication between the host and gut microbiota mediated by metabolites is an important mechanism by which exercise influences the gut microbiota.(4)Phase training typically induces adaptive changes in the gut microbiota,and alterations in the structure or function of the microbiota have lasting effects.(5)The type,quantity,and combination of macronutrients intake can significantly influence the structure and function of the gut microbiota,and interact synergistically or antagonistically with exercise training.(6)In the future,it is important to continue the exploration of the gut microbiota in athletes,clarify causal relationships,and establish new targets for exercise training interventions.

Traditional Chinese Medicine (TCM), as a treasure of the Chinese nation, plays a significant role in maintaining public health. In 2019, the Central Committee of the Communist Party of China and the State Council proposed for the first time the establishment of a TCM registration and evaluation evidence system that integrates TCM theory, "personal experience" and clinical trials (referred to as the "Three-in-One" System) to promote the inheritance and innovation of TCM. Subsequently, the National Medical Products Administration issued several guiding principles to advance the improvement and implementation of this system. Owing to the complexity of its implementation, there are still differing understandings within the TCM industry regarding the positioning of the "Three-in-One" Registration and Evaluation Evidence System, as well as the connotation and value orientation of the "personal experience." To address this, Academician WANG Qi, President of the TCM Association, China International Exchange and Promotion Association for Medical and Healthcare and TCM master, led a group of academicians, TCM masters, TCM pharmacology experts and clinical TCM experts to convene a "Seminar on Promoting the Implementation of the ′Three-in-One′ Registration and Evaluation Evidence System for Chinese Medicinals." Through extensive discussions, an expert consensus was formed, clarifying the different roles of the TCM theory, "personal experience" and clinical trials within the system. It was further emphasized that the "personal experience" is the core of this system, and its data should be derived from clinical practice scenarios. In the future, the improvement of this system will require collaborative efforts across multiple fields to promote the high-quality development of the Chinese medicinal industry.

Objective:To compare the mid- to long-term clinical outcomes of arthrolysis versus revision arthroplasty for arthrofibrosis-related stiffness following total knee arthroplasty (TKA).Methods:A retrospective analysis was conducted of the 20 patients (26 knees) with post-TKA arthrofibrosis who had been treated at Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital between January 2004 and January 2020. The patients were divided into 2 groups based on their treatment: an arthrolysis group of 8 cases (10 knees) [1 male (2 knees)and 7 females (8 knees); median age: 44.0 (21.0, 62.0) years] and a revision arthroplasty group of 13 cases (16 knees) [4 males (6 knees)and 9 females (10 knees); median age: 41.5 (30.0, 56.0) years]. The knee range of motion (ROM) and the American Hospital for Special Surgery (HSS) knee score as well as their improvements were compared between preoperation and the last follow-up, as well as between the 2 groups; the satisfaction of the patients at the last follow-up was compared between the 2 groups.Results:No significant differences in the baseline characteristics were observed between the 2 groups, indicating comparability ( P>0.05). The preoperative knee ROM [55.0° (48.8°, 61.3°)] and HSS knee score [54.0 (47.0, 61.8) points] in the arthrolysis group were significantly higher than those in the revision group [27.5° (6.3°, 50.0°), 33.0 (27.3, 47.8) points] ( P<0.05). In the arthrolysis and revision arthroplasty groups, the knee ROMs [90.0° (65.0°, 100.0°), 90.0° (63.5°, 98.8°)] and HSS knee scores [(69.8±19.9) points, (77.6±11.3) points] at the last follow-up were significantly improved compared with those before operation ( P<0.05). In the revision arthroplasty group, the improvement in knee ROM (48.9°±21.7°) was insignificantly larger than that in the arthrolysis group (34.5°±13.2°) ( P>0.05), but the improvement in HSS knee score [39.5 (25.3, 57.0) points] was significantly larger than that in the arthrolysis group [16.0 (10.5, 25.3) points] ( P<0.05). Respectively, 14 and 3 knees in the revision arthroplasty group and the arthrolysis group resulted in patient satisfaction, showing a significant difference between the 2 groups ( P<0.05). Conclusions:Both arthrolysis and revision arthroplasty can significantly improve knee ROM and HSS knee score in post-TKA arthrofibrosis. However, since revision arthroplasty demonstrates superior improvements in HSS knee score and patient satisfaction, it is preferable for patients with lower preoperative knee ROM.

BACKGROUND:Understanding the characteristics and influencing factors of the gut microbiota in athletes can help determine the optimal gut microbial composition for relevant sport events.Further investigation in this area could provide important insights for improving athletic performance and recovery as well as developing personalized nutrition prescriptions.OBJECTIVE:To summarize the characteristics of gut microbiota in athletes,and to elucidate the important factors influencing the gut microbiota characteristics of athletes from the perspectives of exercise training and dietary intake.METHODS:A literature search was conducted using the PubMed,ScienceDirect,CNKI,WanFang and VIP databases for publications from 2004 to 2024.The search terms included"microbiota,microbiome,athlete,exercise,training,diet,nutrition,dietary fiber,protein,ketogenic,fat"in English and Chinese.After excluding studies of poor quality and irrelevant content,a total of 65 articles were included for review and analysis.RESULTS AND CONCLUSION:(1)The gut microbiota of elite athletes differs from that of the general population,characterized by increased α-diversity,elevated Firmicutes/Bacteroidetes ratio,increased abundance of beneficial bacteria,and enrichment of functional pathways contributing to athletic performance.(2)The type of sport and training load are closely related to the species structure and functional expression of the gut microbiota in athletes.(3)The bidirectional communication between the host and gut microbiota mediated by metabolites is an important mechanism by which exercise influences the gut microbiota.(4)Phase training typically induces adaptive changes in the gut microbiota,and alterations in the structure or function of the microbiota have lasting effects.(5)The type,quantity,and combination of macronutrients intake can significantly influence the structure and function of the gut microbiota,and interact synergistically or antagonistically with exercise training.(6)In the future,it is important to continue the exploration of the gut microbiota in athletes,clarify causal relationships,and establish new targets for exercise training interventions.

Objective:To compare the mid- to long-term clinical outcomes of arthrolysis versus revision arthroplasty for arthrofibrosis-related stiffness following total knee arthroplasty (TKA).Methods:A retrospective analysis was conducted of the 20 patients (26 knees) with post-TKA arthrofibrosis who had been treated at Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital between January 2004 and January 2020. The patients were divided into 2 groups based on their treatment: an arthrolysis group of 8 cases (10 knees) [1 male (2 knees)and 7 females (8 knees); median age: 44.0 (21.0, 62.0) years] and a revision arthroplasty group of 13 cases (16 knees) [4 males (6 knees)and 9 females (10 knees); median age: 41.5 (30.0, 56.0) years]. The knee range of motion (ROM) and the American Hospital for Special Surgery (HSS) knee score as well as their improvements were compared between preoperation and the last follow-up, as well as between the 2 groups; the satisfaction of the patients at the last follow-up was compared between the 2 groups.Results:No significant differences in the baseline characteristics were observed between the 2 groups, indicating comparability ( P>0.05). The preoperative knee ROM [55.0° (48.8°, 61.3°)] and HSS knee score [54.0 (47.0, 61.8) points] in the arthrolysis group were significantly higher than those in the revision group [27.5° (6.3°, 50.0°), 33.0 (27.3, 47.8) points] ( P<0.05). In the arthrolysis and revision arthroplasty groups, the knee ROMs [90.0° (65.0°, 100.0°), 90.0° (63.5°, 98.8°)] and HSS knee scores [(69.8±19.9) points, (77.6±11.3) points] at the last follow-up were significantly improved compared with those before operation ( P<0.05). In the revision arthroplasty group, the improvement in knee ROM (48.9°±21.7°) was insignificantly larger than that in the arthrolysis group (34.5°±13.2°) ( P>0.05), but the improvement in HSS knee score [39.5 (25.3, 57.0) points] was significantly larger than that in the arthrolysis group [16.0 (10.5, 25.3) points] ( P<0.05). Respectively, 14 and 3 knees in the revision arthroplasty group and the arthrolysis group resulted in patient satisfaction, showing a significant difference between the 2 groups ( P<0.05). Conclusions:Both arthrolysis and revision arthroplasty can significantly improve knee ROM and HSS knee score in post-TKA arthrofibrosis. However, since revision arthroplasty demonstrates superior improvements in HSS knee score and patient satisfaction, it is preferable for patients with lower preoperative knee ROM.

Objective:To study the effects of metformin on marginal bone resorption of implants in patients with type 2 diabetes melli-tus(T2DM)and exercise habit.Methods:63 cases with 73 implants were included.Among them,there were 41 cases(47 implants)without T2DM in group N,10 cases(13 implants)with T2DM and without exercise habit in group M,12 cases(12 implants)with T2DM and exercise habit in the MR group.The patients were followed up at 6 months,1 and 2 years after implantation.The marginal bone loss(MBL).Implantation success rate and peri-implantitis incidence rate were compared among the groups.Results:The bone resorption of the proximal and median margins of the long-term bone level of the implants in the N and MR groups were significantly lower than that in the M group(P=0.001 and P=0.000 5,respectively).The implant success rates of group N,MR and M were 95.74％,100％and 76.92％,respectively.The incidence of peri-implantitis of the three groups was 2.13％,0 and 15.38％,respec-tively.Conclusion:Metformin is more effective in the improvement of the long-term marginal bone resorption of implants,increase the success rate of implants,and reduce the incidence of peri-implantitis in patients with T2DM and exercise habit in the mandibular first molar area.

Objective To explore the role of different CVP levels in the occurence and development of sepsis-associated acute kid-ney injury(SA-AKI).Methods Sepsis model was induced using the cecal ligation and puncture(CLP)method for 24h in male SD rats,with a sham group as the control.The rats in two groups were intravenously infused with Ringer's solution to induce an increase in CVP to 10,15 and 20mmHg,respectively.The hemodynamic parameters including mean arterial pressure(MAP),heart rate(HR),and arterial blood lactate(Lac)were dynamically monitored in rats.And side stream darkfield imaging(SDF)technique was used to de-tect the renal cortex microcirculation perfusion parameters including perfused small vessel density(PVD)and microvascular flow index(MFI).Renal injury markers including serum creatinine(CRE),urine neutrophil gelatinase associated lipocalin(NGAL),renal inflam-matory factor interleukin-6(IL-6)levels and renal histopathological changes were also detected.Results Compared with the sham group,the MAP of CLP rats significantly decreased,while HR and Lac significantly increased(P＜0.05).The renal PVD and MFI were significantly decreased(P＜0.05),while serum CRE,urine NGAL,and renal IL-6 were significantly increased(P＜0.05).Com-pared with CVP 10mmHg,the PVD and MFI of CLP rats were significantly decreased at CVP 20mmHg(P＜0.05);The PVD and MFI of sham group at CVP 15mmHg and 20mmHg were significantly lower than those of the CVP at CVP 10mmHg(P＜0.05).The IL-6 of CLP rats at CVP 15mmHg was significantly higher than that at CVP 10mmHg(P＜0.05),and the IL-6 levels at CVP 20mmHg were significantly higher than at CVP 15mmHg(P＜0.05).In CLP rats,increasing CVP led to cortical and medullary edema,vacuolar degen-eration of renal tubular epithelial cells,loss of brush borders,tubular obstruction,and disappearance of Bowman's space;medullary ede-ma was more pronounced than in the cortex.In the sham group,glomerular and tubular swelling occurred at CVP 20mmHg,and Bowman's space became narrower.Conclusion Excessive CVP levels can decrease renal cortical microcirculation perfusion and promote the acti-vation of local inflammation and renal tissue edema in CLP rats,which exerting a detrimental effect during the process of S-AKI.

Total hip arthroplasty(THA)is an effective treatment for elderly femoral neck fractures,mid-to late-stage femoral head necrosis,and end-stage hip osteoarthritis.However,serious complications such as aseptic loosening of the prosthesis,peripheral fractures,and dislocation of the prosthesis still exist following THA,which makes the selection of the appropriate hip prosthesis type and placement position before THA an important challenge for surgeons.Currently,the commonly used preoperative planning methods for THA mainly rely on static images from two-dimensional(2D)X-ray or three-dimensional(3D)computed tomography(CT),which fail to adequately consider the hip joint in weight-bearing as well as motion,lumbar-hip joint changes,and prosthetic impingement during motion.Recently,the dual fluoroscopic imaging system,as a new in-vivo,dynamic radiological imaging technology,provides comprehensive and accurate dynamic 3D data for THA preoperative planning.However,the technical process and expert consensus on preoperative 3D planning of THA using a dual fluoroscopic imaging system have not yet been established,which affects the promotion and application of this technology.In light of the above,national orthopaedic experts and related professional representatives discussed and proposed seven consensus issues,and the'expert recommendation rate'and'strong recommendation rate'were obtained through a questionnaire survey on the recommendations of the participating experts.This consensus aims to provide guidance and reference for the standardised application of preoperative 3D planning of THA using the dual fluoroscopic imaging system.

Total hip arthroplasty(THA)is an effective treatment for elderly femoral neck fractures,mid-to late-stage femoral head necrosis,and end-stage hip osteoarthritis.However,serious complications such as aseptic loosening of the prosthesis,peripheral fractures,and dislocation of the prosthesis still exist following THA,which makes the selection of the appropriate hip prosthesis type and placement position before THA an important challenge for surgeons.Currently,the commonly used preoperative planning methods for THA mainly rely on static images from two-dimensional(2D)X-ray or three-dimensional(3D)computed tomography(CT),which fail to adequately consider the hip joint in weight-bearing as well as motion,lumbar-hip joint changes,and prosthetic impingement during motion.Recently,the dual fluoroscopic imaging system,as a new in-vivo,dynamic radiological imaging technology,provides comprehensive and accurate dynamic 3D data for THA preoperative planning.However,the technical process and expert consensus on preoperative 3D planning of THA using a dual fluoroscopic imaging system have not yet been established,which affects the promotion and application of this technology.In light of the above,national orthopaedic experts and related professional representatives discussed and proposed seven consensus issues,and the'expert recommendation rate'and'strong recommendation rate'were obtained through a questionnaire survey on the recommendations of the participating experts.This consensus aims to provide guidance and reference for the standardised application of preoperative 3D planning of THA using the dual fluoroscopic imaging system.

Bariatric surgery is the most effective treatment for patients with severe obesity, which can significantly improve the metabolic disorders, especially type 2 diabetes mellitus. Bariatric and metabolic surgery is the latest and fastest-growing branch of surgery, with the types of procedure and other novel treatment modalities are still evolving and in progress. The authors summarize the recent advancement related to novel bariatric and metabolic surgery in the treat-ment of morbid obesity and type 2 diabetes mellitus in recent years through literature search, which can be divided into the following three parts: (1) novel surgical procedures and new guideline of indication. Sleeve gastrectomy and Roux-en-Y gastric bypass are the most performed bariatric surgery. Duodenal switch or the variant of one anastomosis duodenal ileostomy are also accredited procedures but been less performed. One anastomosis gastric bypass is the most recently accredited bariatric surgical procedures with better safety profile and weight loss efficacy than most of the procedures. For other novel procedures, bipartition procedure may be the next accredited proce-dure. A new worldwide guideline is recently launched and the indication for bariatric surgery is lowered BMI 27.5 kg/m 2 for Asian. (2) The effect and mechanism of bariatric surgery. Bariatric surgery can significantly reduce the incidence of cardiovascular disease and mortality in obese patients. The main beneficiary group is patients with diabetes mellitus. Along with the recent basic research and the success of new gut hormone related drugs, the mechanism of bariatric surgery can be mostly attributed to gut hormonal effect, however, gastric volume still play an important role. (3) Novel obesity treatment modalities. Endoscopic obesity treatment has a major progress in the success of endoscopic gastroplasty by endoscopic suturing designs. More noteworthy is the development of new intestinal hormone drug therapy, which can achieve a weight loss of 14% in one year by injec-ting once a week glucagon-like peptide-1 preparation, and then combining two or three intestinal hormone drugs can achieve a weight loss of 24% in one year, which is close to the effectiveness of bariatric surgery. Pharmacologic treatment of obesity is very promising and expected. With the increasing severity of obesity and diabetes mellitus in the world, in addition to the explosive develo-pment of bariatric and metabolic surgery in recent years, many new surgical methods and new treatments, especially new and effective intestinal hormone related therapeutic drugs, have been developed. The success of bariatric and metabolic surgery depends on a multidisciplinary team with rich clinical experience: precise preoperative planning and comprehensive postoperative manage-ment, as well as patient understanding and cooperation, in order to achieve the best results.