Objective: To investigate the therapeutic efficacy and potential mechanisms of fecal microbiota transplantation (FMT) in patients with type 2 diabetes mellitus (T2DM), and to preliminarily identify the traditional Chinese medicine (TCM) syndrome element characteristics of FMT in the treatment of T2DM. Methods: Between March 25, 2023 and September 30, 2024, T2DM patients who met the inclusion and exclusion criteria were enrolled at the Department of Rheumatology and Endocrinology of the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine. Participants received oral microbiota capsules as an adjunct to metformin therapy. Information obtained by four diagnostic methods of TCM, along with clinical and laboratory parameters, was collected before and after the intervention. Metagenomic sequencing was employed to analyze the gut microbiota, and Spearman correlation analysis was used to explore the relationship between laboratory indicators and differential bacterial genera. According to the post-treatment reduction in glycosylated hemoglobin (HbA1c), patients were categorized into a response (R) group and a non-response (NR) group. Treatment outcomes, safety indicators, gut microbiota changes, and TCM syndrome element features were compared between the two groups. Results: A total of 53 T2DM patients were included in the final analysis, and 30 patients were assigned to R group and 23 to NR group. After treatment, the R group exhibited significant reductions in HbA1c, fasting plasma glucose (FPG), and 2-hour postprandial glucose (2hPG) (P < 0.05 or P < 0.01). The NR group also showed significant decreases in HbA1c and FPG levels P < 0.01 or P < 0.05. Compared with the NR group, after treatment, FPG level in the R group demonstrated significant reductions (P < 0.01). As compared with before treatment, pancreatic islet function demonstrated enhancement in the R group, a significant increase in the 2-hour pastprandial C-peptide (2hC-P) levels in R group (P < 0.05), whereas no marked change was observed in the NR group. Regarding body composition indicators, the R group showed significantly lower waist-hip ratio (WHR), visceral fat (VF), and subcutaneous fat (SF) levels compared with the NR group (P < 0.01). After treatment, the NR group exhibited a significant elevation in aspartate aminotransferase (AST) levels (P < 0.05). Other safety-related indicators fluctuated within normal reference ranges, and no other adverse events, such as diarrhea, fever, or nausea, were reported. Metagenomic sequencing showed that FMT improved the diversity and richness of the gut microbiota, remodeling its overall structure. At the phylum level, the abundance of p_Firmicutes decreased significantly (P < 0.01), while the abundances of p_Bacteroidota and p_Proteobacteria increased significantly (P < 0.01). At the family level, among the 125 identified taxa, the abundances of f_Bacteroidaceae, f_Lactobacillaceae, and f_Sutterellaceae were significantly elevated, whereas six families, including f_Lachnospiraceae, f_Ruminococcaceae, and f_Coriobacteriaceae, were significantly decreased (all P < 0.05). Among the 367 taxa at the genus level, the top 10 differential genera showed significantly increased abundances of g_Bacteroides and g_Sutterella, and significantly decreased abundances in eight genera, including g_Faecalibacterium, g_Ruminococcus, g_Blautia, and g_Collinsella (all P < 0.05). Correlation analysis suggested that the phylum p_Bacillota was positively correlated with improvements in T2DM laboratory parameters, g_norank_f_Prevotellaceae was significantly positively correlated with fasting C-peptide (FC-P) and 2hC-P (P < 0.05). HbA1c demonstrated a significantly positive correlation with g_Blautia and g_Gemmiger (P < 0.05) and a significantly negative correlation with g_Bacteroides and g_Collinsella (P > 0.05). Analysis of syndrome element characteristics revealed that the R group was primarily characterized by pathological patterns of dampness, phlegm, and Yang deficiency. Before treatment, statistically significant reductions in syndrome element scores were observed for dampness, Yang deficiency, spleen, phlegm, Qi deficiency, Qi stagnation, and Yin deficiency (P < 0.01), as well as for heat and liver (P < 0.05). The NR group was mainly featured with Qi deficiency and Yin deficiency. Statistically significant changes in their syndrome element scores after treatment were noted for Qi deficiency (P < 0.01), and for spleen, Qi stagnation, liver, and blood deficiency (P < 0.05). In this group, the score changes for Yang deficiency, Yin deficiency, heat, and dampness were not statistically significant (P > 0.05). Conclusion The principles of syndrome element differentiation can be effectively applied to predict treatment efficacy and facilitate patient selection for FMT in the treatment of T2DM. Patients with T2DM presented with specific TCM syndrome element characteristics, notably dampness, phlegm, and Yang deficiency, represent a highly responsive population to FMT therapy.

In recent years， adaptive design has gradually emerged in clinical trials， gaining widespread application and expansion. Compared with traditional randomized controlled trials， appropriate adaptive design can save time and resources to some extent， improve the validity of the trial results and strength of the evidence， align better with ethical requirements， and facilitate subsequent drug market research. However， due to the greater flexibility of adaptive design， controlling type Ⅰ error rates and truly enhancing research efficiency are challenging aspects of its application. Therefore， the normative application and optimization of adaptive design in research deserve early focus， including adhering to good adaptive design principles， conducting rigorous pre-design planning， scientifically applying various statistical methods such as Bayesian dynamic models and simulation methods， and utilizing monitoring tools like monitoring committees to ensure the scientific integrity of the research process. Moreover， the flexibility of adaptive design aligns well with the practical realities of traditional Chinese medicine （TCM） clinical practice. The main characteristics of TCM， such as the holistic concept and treatment based on syndrome differentiation， determine that TCM provides a dynamic and personalized treatment plan. In contrast， the traditional fixed development approach of western medicine limits the application of "human experience" in TCM. To address this bottleneck in TCM research and development， the innovative use of adaptive design， a modern scientific theory and methodology with multiplicity and variability， offers a feasible new approach for TCM clinical research and the innovation of Chinese herbal medicine. By learning from successful cases such as the first Food and Drug Administration （FDA）-approved oral botanical drug， Crofelemer， researchers can explore optimal solutions for adaptive design in clinical research protocols and its role in the "three-combination" evaluation system for Chinese herbal medicines， further refine trial design， clarify key trial points， and develop innovative research and development applications that adapt to the clinical positioning of TCM and highlight the characteristics and advantages of TCM， paving the way for the clinical efficacy， pharmacological mechanism exploration， and post-market efficacy evaluation of Chinese herbal compounds.

Objective To explore the impact of bisphenol A(BPA)exposure on liver lipid metabolism in C57BL/6J mice and uncover the mechanisms at work.Methods Male C57BL/6J mice,aged eight weeks,were stratified into six cohorts:a control group on a standard diet(ND),a group on a standard diet with low-dose BPA(BPA-50 ND),a group on a standard diet with high-dose BPA(BPA-500 ND),a control groupon a high-fat diet(HFD),a group on a high-fat diet with low-dose BPA(BPA-50 HFD),and a group on a high-fat diet with high-dose BPA(BPA-500 HFD).Dosages for the low-and high-dose BPA groups were 50 and 500 μg/(kg·d),respectively,administered via gavage over a duration of 12 weeks.Hepatic tissue underwent histological examination through he-matoxylin and eosin(HE)staining.Furthermore,the expression levels of miR-122-5p and miR-143-3p in hepatic tissue,in addition to interleukin(IL)-6 and IL-10 in peripheral serum,were quantitatively measured employing quantitative reverse transcription-polymerase chain reaction(qRT-PCR)and enzyme-linked immunosorbent assay(ELISA),respectively.Results Histopathological analysis via HE staining indicated intact hepatic lobule archi-tecture in the ND group,whereas other groups displayed variable degrees of lipid droplet accumulation and damage to hepatic lobules.Notably,supplementation with BPA,particularly in conjunction with a high-fat diet,led to a progressive increase in IL-6 levels and a decrease in IL-10 levels in peripheral blood.In the context of a standard diet,an augmentation in BPA concentration corresponded with a decline in the expression of miR-122-5p and miR-143-3p.Conversely,within the high-fat diet cohort,enhanced BPA concentrations were associated with increased expressions of these microRNAs.Pearson correlation analysis disclosed a significant positive correlation between the expression of miR-122-5p and miR-143-3p and the level of IL-10 in the standard diet group(P＜0.01).In the high fat diet group,the expression level of miR-122-5p was positively correlated with the concentration of IL-6(P＜0.05),and the expression level of miR-143-3p was negatively correlated with the concentration of IL-10(P＜0.05).Conclusion BPA can induce the occurrence and progression of nonalcoholic fatty liver disease(NAFLD)by regulating the expression of miR-122-5p and miR-143-3p and regulating the levels of inflammatory factors IL-6 and IL-10.

Objective:To optimize and compare method for hepatitis E virus (HEV) nucleic acid detection from pig liver, and provide technical references for HEV detection in animal viscera specimens.Methods:Three methods (PBS homogenization treatment, proteinase K treatment, chloroform extraction method) were used to pretreat and extract viral nucleic acid form pig liver, which was artificially contaminated with HEV fecal suspensions, and HEV RT-qPCR was used to compare the HEV recovery rate and inhibition rate. The optimized HEV method was applied to commercially available pig liver specimens, and HEV genotyping was performed on positive specimens.Results:The HEV recovery rate of PBS homogenization treatment, proteinase K treatment and chloroform extraction method was 9.88%, 0.19% and 17.28%, respectively. The recovery rate of proteinase K treatment was less than 1%, and it was discarded; t-test was performed to compare recovery rates of the other two methods, which showed statistically significant differences ( t=26.801, P<0.001), the chloroform extraction method had a higher recovery rate. The inhibition rates of the three methods were all less than 75%, within the range of the ISO/TS 15216-2∶2019 standard. Among 192 commercially available pig liver specimens, 17 specimens were detected positive for HEV RNA, with a nucleic acid positive rate of 8.85%; five specimens were successfully genotyped for HEV, all of which were genotype 4. Conclusions:The virus recovery effect was good when chloroform extraction method was used for pig liver pretreatment; moreover, this method could detect HEV RNA from commercially available pig livers, which indicate that it can be used for virus detection in food.

Robotic surgery is known as the"third technological revolution"in the field of surgery,and is an important milestone in the development of modern surgery.However,our country's innovative surgical robot industry is still in its early stages,and it is only being utilized in certain surgical fields.To explore the effectiveness of the application of do-mestic surgical robot in oral and maxillofacial surgery,the author successfully completed a case of benign parotid tumor resection with the assistance of a domestic autonomous robot.The operation was successful,facial nerve function was preserved,and postoperative wound healing was good.

Objective This study aims to establish an approach to integrate autonomous maximal smile(AMS)3D facial image with digital 3D dental models to demonstrate the digital orthodontic set-up in the 3D facial context.Methods Using Geomagic Studio software,the AMS 3D facial image and pre-treatment dental model were manually and globally registered.Subsequently,the pre-treatment dental model was substituted with the predicted post-treatment dental model.The intraoral region of the AMS 3D facial image was removed,achieving a conjunctive display of the AMS 3D facial image and the post-treatment dental set-up.The distances between four groups of corresponding landmark pairs on the AMS 3D facial image and the pre-treatment dental set-up were calculated,and the accuracy of the registration operation was evaluated by paired t-test.Results The novel approach effectively facilitated the integration of AMS 3D facial images with the pre-treatment and predicted post-treatment 3D dental models.The average distances between the pairs of points were(1.19±0.55)mm and(1.55±0.59)mm for the two registrations,respectively.Notably,no statistically significant difference was observed be-tween the two measurements(P>0.05),indicating a high agreement(intraclass correlation coefficient=0.914).Conclu-sion This study established an approach to integrate AMS 3D facial images with digital 3D dental models.Through this approach,the digital orthodontic set-up design can be displayed in the context of a 3D facial image,which may help to improve the quality of outcome set-up in digital orthodontics,such as clear aligner therapy.

Objective:The principal components (PC) of venous-to-arterial carbon dioxide content diference [C(v-a)CO 2] were extraceted in septic shock patients, in orter to compare the contribution of the principal components to C(v-a)CO 2. Methods:Septic shock patients monitored by Swan Ganz floating catheter in the Medical Intensive Care Unit of Peking Union Medical College Hospital were included in the retrospective study. All pairs of arterial and mixed-venous blood gases within 1 h before and after a flood challenge were included in the analyses. The principal component method was used to extract the components of C(v-a)CO 2. Spearman correlation analysis was used to evaluate the correlation between the components and C(v-a)CO 2, and the correlation between the components and cardiac output. The differences of the components beween the 28-day survival group and 28-day death group were analyzed by univariate analysis. Results:A total of 504 pairs of blood gases in 104 septic shock patients were included in the analyses. The median age of patients was 62 years ( IQR, 48 to 71), and 59.6% (62/104) were men. Four principal components were extracted and the components account for 77.7% of variance. PC1 included PaO 2, PvO 2, SaO 2 and SvO 2. PC2 included pHa and pHv. PC3 included Hb and Hct. PC4 included PaCO 2 and PvCO 2. There was a significant difference in PC4 between the two group. PC4 could weakly predict the 28-day death (AUROC 0.634, 95% CI 0.527-0.741, P=0.015). Conclusions:In patients with infectious shock, arteriovenous [C(v-a)CO 2] consists of principal components of four dimensions: oxygenation, pH, Hb, and CO 2 partial pressure difference.Arterial CO 2 partial pressure difference [P(v-a)CO2] weakly predicts 28-d morbidity and mortality.

Macrophages have strong plasticity and heterogeneity,and can undergo functional transformation in response to different signal stimuli,such as classical activation of M1 type(M1 type polarization)and selective activation of M2 type(M2 type polarization).The pathways of macrophage M1/M2 polarization are quite extensive,involving nuclear factor-κB(NF-κB)/mitogen-activated protein kinase(MAPK)signaling pathway,interleukin-4(IL-4)/signal transduction and activator of transcription 6(STAT6)signaling pathway,Notch signaling pathway,Wnt/β-catenin signaling pathway,etc.At the same time,M1/M2 polarization of macrophages is also regulated by exosomes,metabolites,non-coding RNA,electrical stimulation,probiotics,etc.,and its imbalance is closely related to the occurrence and development of different types of liver disease.In this paper,the mechanism of its polarization was reviewed,and it was found that M1 polarization of macrophages played a promoting role in the process of liver tissue injury,inflammation and fibrosis,while M2 polarization of macrophages played the opposite role.Among them,hepatocellular carcinoma,as the advanced stage of chronic liver disease,was characterized by increased M2 polarization and impaired M1 polarization of macrophages.Therefore,this paper pays attention to the role of M1/M2 polarization of macrophages in different types of liver diseases,in order to better establish the targeted therapy of macrophage subsets.

Venous thromboembolism(VTE)is a prevalent complication in orthopedics.In recent years,machine learning has been widely applied in orthopedics.The essence of machine learning lies in utilizing algorithms to analyze vast amounts of data and construct risk prediction models that can accurately forecast unknown clinical outcomes.By integrating high-risk factors,machine learning aids medical professionals in precisely identifying and screening individuals with a high risk of VTE and offering them timely individualized interventions.This article reviews the concept and classification of machine learning,the advantages of machine learning in enhancing model prediction ability,and the current application status of machine learning in constructing risk prediction models for patients with VTE.

Acute amnestic syndrome manifests as transient or persistent symptoms of single amnesia,which may also be accompanied by other neurological symptoms,eventually leading to irreversible brain damage.The typical symptoms of acute ischemic stroke include hemiplegia,aphasia,sensory disturbances,and so forth.Acute amnesia is not a typical symptom of acute ischemic stroke,and it is easy to misdiagnose or delay diagnosis in the emergency department.The authors retrospectively analyzed the clinical data of a patient with acute cerebral infarction who started with acute amnesia syndrome,and combined with relevant literature,to explore its clinical characteristics and pathogenesis.The purpose of this article is to provide reference for emergency physician and neurologist in the diagnosis and treatment of similar cases.