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.

Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

Objective To construct prostate cancer(PCa)prediction models based on machine learning algorithms, so as to improve the accuracy of early diagnosis of PCa. Methods A retrospective analysis was performed on the clinical data of 504 patients who underwent prostate biopsy at our hospital during Jan. 2020 and Nov. 2024. Patients' age, body mass index(BMI), history of hypertension, diabetes and smoking, total prostate-specific antigen(tPSA), free prostate-specific antigen(fPSA), f/tPSA, prostate volume(PV), neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio(NLR), Prostate Imaging Reporting and Data System(PI-RADS)score, digital rectal examination(DRE)results, and pathological findings were collected. The patients were divided into the training and testing sets at a ratio of 7:3. Ten early diagnosis prediction models of PCa were constructed using 10 supervised machine learning algorithms. Model performance was evaluated and validated using metrics including area under the receiver operating characteristic curve(AUC), accuracy, sensitivity, specificity, calibration curves, and decision curve analysis(DCA). SHAP analysis was used to interpret the models, and to clarify the importance of each feature and the basis for model decisions. Results All models showed good predictive value, with the gradient boosting machine(GBM)model performing the best(AUC=0.905, accuracy=84.1%, sensitivity=90.2%, specificity=80.0%). Calibration curves indicated good calibration and fitting of the GBM model, while DCA demonstrated favorable clinical net benefits. SHAP analysis identified the most significant features affecting PCa occurrence in descending order:tPSA, f/tPSA, PIRADS score, PV, age, and DRE. Conclusion The GBM model exhibits the optimal performance among the 10 models. The importance of features for predicting the occurrence of PCa, from the highest to the lowest, is as follows:tPSA, f/tPSA, PIRADS score, PV, age, and DRE.

Objective: To investigate the efficacy and safety of intelligent temperature-pressure-controlled flexible ureteroscopy combined with negative-pressure suction sheath lithotripsy in the treatment of upper urinary tract stones ≤2.5 cm. Methods: The clinical data of 225 patients with ≤2.5 cm upper urinary tract stones treated with this surgical method in our department during Aug. 2023 and Jul. 2024 were retrospectively analyzed. The patients were divided into the dual-control group (n=36) and conventional group (n=189) according to whether or not the intelligent temperature and pressure control device was used during operation. In the dual-control group，the intraoperative temperature and pressure in the renal pelvis were monitored and controlled in real time by the temperature and pressure sensors distributed at the end of the ureteral soft lens. The perioperative parameters，stone-removal rate，complication rate and renal function were compared between the two groups. Results: All operations were successfully completed in both groups. The postoperative procalcitonin (PCT) level [(22.75±5.85) ng/L vs. (29.08±6.60) ng/L，P=0.001]，difference in the white blood cell (WBC) level [(0.24±2.12)×10 cells/L vs. (1.19±2.17)×10 cells/L，P=0.016]，incidence of fever (2.8% vs. 16.9%，P=0.028) and overall complication rate (5.6% vs. 19.6%，P=0.042) were significantly lower in the dual-control group than in the conventional group，while the stone-clearance rate was slightly higher (88.9% vs. 82.5%，P=0.346)，with no significant difference. Conclusion: For upper urinary tract stones ≤2.5 cm，intelligent temperature-pressure-controlled ureteroscopy combined with negative-pressure suction sheath lithotripsy has a satisfactory stone-removal rate and a low rate of complications，which is worthy of clinical promotion.

Objective To identify the taste critical quality attribute and design and optimize the flavor-correcting formulation of the traditional Chinese medicine oral preparation Qingre Jiedu Oral Liquid,in order to improve its taste and enhance patient medication adherence.Methods The taste assignment method was employed to identify the taste critical quality attribute of Qingre Jiedu Oral Liquid.Based on human sensory evaluation and the standardized Euclidean distance in electronic tongue analysis,suitable types of corrigent were determined.Subsequently,under constraints such as maximum allowable dosage,solubility,and sweetness,the optimal taste formulation for the sugar-free intermediate of Qingre Jiedu Oral Liquid was determined using Box-Behnken experimental design combined with electronic tongue and human sensory evaluation results.The study was reviewed and approved by the Ethics Committee of Beijing University of Chinese Medicine(Ethics Approval Number 2020BZYLL0609).Results The quantitative score for bitter taste of Qingre Jiedu Oral Liquid accounted for 30.36%,confirming bitterness as the taste critical quality attribute requiring attention.The optimal taste formulation for the sugar-free intermediate of Qingre Jiedu Oral Liquid was determined to be 120 mg·mL?1 erythritol,12 mg·mL?1 acesulfame potassium,and 2.4 mg·mL?1 stevioside.This formulation achieved an 11.75-point improvement in sensory evaluation scores compared to the original commercially available oral liquid.Conclusion This study successfully improved the taste of Qingre Jiedu Oral Liquid and established a comprehensive strategy for flavor-correcting formulation optimization,including a method for identifying taste critical quality attribute.This strategy provides a referential paradigm for palatability enhancement of similar traditional Chinese medicine oral preparations,laying a crucial technical foundation for elevating the clinical value of Chinese herbal medicines and promoting the high-quality development of traditional Chinese medicine(TCM).

Objective:To investigate the current status and influencing factors of ICU nurses' perception of risks and benefits of family presence during resuscitation, and to provide scientific evidence for the formulation of relevant policies in medical institutions.Methods:A convenience sampling method was used to recruit 370 ICU nurses from four Class Ⅲ Grade A hospitals in Taizhou between October and December 2024. A general information questionnaire, the Chinese version of the Family Presence Risk-Benefit Scale (FPR-BS), and the Chinese version of the Family Presence Self-Confidence Scale (FPS-CS) were used. Hierarchical multiple linear regression was applied to explore the influencing factors of ICU nurses' perception of risks and benefits of family presence during resuscitation.Results:A total of 370 questionnaires were distributed, and 357 valid questionnaires were collected, with a valid response rate of 96.49%. The total score of the Chinese version of FPR-BS among 357 ICU nurses was (50.25±10.54), and the total score of the Chinese version of FPS-CS was (40.36±8.19). Hierarchical multiple linear regression analysis showed that gender, age, years of work experience, educational level, number of times participating in resuscitation, and self-confidence regarding family presence during resuscitation were influencing factors of risk-benefit perception ( P<0.05) . Conclusions:ICU nurses' perception of the risks and benefits of family presence during resuscitation was at a relatively low to moderate level. Self-confidence regarding family presence during resuscitation was correlated with risk-benefit perception. When implementing policies on family presence during resuscitation, medical institutions should first improve nurses' self-confidence in this regard and provide targeted support.

Objective:To explore the independent factors influencing extraprostatic extension (EPE) after radical prostatectomy(RP) in patients with clinically localized prostate cancer by utilizing the Surveillance, Epidemiology, and End Results (SEER) database. A nomogram model was developed and externally validated.Methods:Clinical and pathological data of 20 916 clinically localized prostate cancer patients (T 1-2N 0M 0) who underwent RP between 2010 and 2021 were extracted from the SEER database. The mean age was (61.71±7.09) years old, and a total of 17 835 patients (85.3%) were married.There were 2 243 patients (10.7%) with prostate-specific antigen (PSA) <4 ng/ml, 14 831 patients (70.9%) with ≥4 and <10 ng/ml, and 2 965 patients (14.2%) with ≥10 and <20 ng/ml. There were 14 870 patients (71.1%) with clinical staging of stage T 1, and 6 046 patients (28.9%) with T 2. There were 48 patients (0.2%) with pathological staging of stage T 1, 15 794 (75.5%) with T 2, 5 001(23.9%) with T 3, and 73 (0.3%) with T 4 stage after radical surgery.The patients of SEER database were divided into training and internal validation groups in a 7∶3 ratio by using stratified sampling. Additionally, data were collected for 75 clinically localized prostate cancer patients who underwent RP at the Second Affiliated Hospital of Zhengzhou University from September 2019 to September 2024, serving as the external validation group.The mean age was(65.39±7.45) years old. Among them, 73 (97.3%) were married. There were 2 patients (2.7%) with PSA <4 ng/ml, 17 patients (22.7%) with ≥4 and <10 ng/ml, and 34 patients (45.3%) with ≥10 and <20 ng/ml. There were 47 patients (62.7%) with clinical staging of stage T 1, and 28 patients (37.3%) with T 2. There were 7 patients (9.3%) with pathological staging of stage T 1, 48 patients (64.0%)with T 2, 18 patients (24.0%) with T 3, and 2 patients (2.7%) with T 4 stage after radical surgery. All patients were categorized into organ-confined (OC) and EPE groups based on post-surgical pathology. Univariate and multivariate logistic regression analyses, with a stepwise backward selection, were performed on the training group to identify independent risk factors of EPE, which were used to construct a nomogram model. Model performance was assessed using receiver operating characteristic (ROC) curve area under the curve (AUC), calibration curves, and decision curve analysis (DCA) for the training group, internal validation group, and external validation group. Results:EPE was observed in 3 585 cases (24.5%), 1 489 cases (23.8%), and 20 cases (26.7%) in the training, internal validation, and external validation groups, respectively. Logistic regression analyses identified preoperative age ( OR=1.026, P<0.001), PSA levels (≥10 and <20 ng/ml: OR=1.790, P<0.001; ≥20 ng/ml: OR=2.683, P<0.001), tumor maximum diameter (10-20 mm: OR=2.051, P<0.001; >20 mm: OR=3.937, P<0.001), biopsy Gleason score (score 7: OR=1.911, P<0.001; score 8: OR=2.906, P<0.001; score 9: OR = 5.278, P<0.001; score 10: OR=4.421, P=0.003), number of positive biopsy cores (≥4 cores: OR=1.260, P<0.001), and their proportion of total cores ( OR=1.012, P<0.001) as independent predictors of EPE. The nomogram model demonstrated good predictive performance, with AUC of 0.741, 0.748, and 0.724 in the training, internal validation, and external validation groups, respectively. Calibration and DCA curves confirmed the model’s excellent stability and generalizability. Conclusions:Age, PSA levels, maximum tumor diameter, biopsy Gleason score, number of positive biopsy cores, and their proportion of total cores are independent predictors of EPE after RP in clinically localized prostate cancer. The constructed model effectively predicts the risk of EPE occurrence.

Artificial intelligence(AI)is reconstructing drug quality control systems with unprecedented depth.With the rapid development of the traditional Chinese medicine(TCM)industry,the quality regulation of TCM has garnered increasing attention.The efficacy and safety of TCM directly impact public health,making it imperative to enhance the scientific rigor and effectiveness of its quality control.In recent years,the application of AI technology has expanded across various fields,and its potential in TCM quality regulation has gradually been recognized.Cur-rently,AI has demonstrated advantages in multiple stages of TCM production,including cultivation and planting,authenticity identification of decoction pieces,compliance review of manufacturing processes,market circulation monitoring,and risk assessment.However,despite existing research achievements,challenges such as limited technological adoption,low standardization,and insufficient data sharing persist.This paper provides an in-depth review of innovative AI applications in TCM quality control,comprehensively analyzes their effectiveness and future prospects,and proposes a novel"AI-Digital Sensory-Blockchain"tri-synergistic quality control paradigm based on domestic and international research advancements.Furthermore,it explores potential future research directions to advance the modernization of TCM quality regulation,thereby achieving higher levels of safety assurance and scien-tifically robust supervision.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.