The liver is a vital metabolism and detoxification organ of human body, which is involved in the biotransformation and metabolism of the organism. Hepatitis - cirrhosis - liver cancer are significant and common part of liver diseases. The pathogenesis of liver diseases is generally as followed: inflammation and other pathogenic factors cause persistent damage to the liver, leading to the activation of hepatic stellate cells (HSCs) and excessive deposition of extracellular matrix. Patients with chronic hepatitis have a high risk of developing into liver fibrosis, cirrhosis, and even life-threatening liver cancer, which poses a great threat to public health.As the first organ to come into contact with blood from the gut, the liver is profoundly affected by the intestinal flora and its metabolites, with leaky gut and flora imbalance being the triggers of the liver’s pathological response. So far, no one has reviewed the role of intestinal flora in this process from the perspective of the progression of hepatitis-cirrhosis-liver cancer and this article reviews the evidence supporting the effect of intestinal flora in the progression of liver disease.

The relationship between drinking and sarcopenia remains controversial. The aim of the present study was to investigate the association of alcohol drinking with sarcopenia in the older adults. A prospective study with 5244 Chinese community-dwelling older adults aged ≥65 years was performed. Sarcopenia was assessed by appendicular skeletal muscle mass index, grip strength, and gait speed. A quantitative questionnaire was used to obtain the information of alcohol drinking. After 4-year follow-up, our study showed that drinkers had lower incidence of sarcopenia than those non-drinkers (19.4% vs. 30.4%, P < 0.001 in males and 9.5% vs. 20.4%, P = 0.004 in females, respectively). Moreover, male drinkers had higher levels of muscle mass [median (IQR): 7.3 (6.7–7.9) kg/m² vs. 7.1 (6.5–7.7) kg/m², P < 0.001] grip strength [median (IQR): 31.1 (26.5–35.0) kg vs. 29.6 (24.8–38.8) kg, P < 0.001], and gait speed [median (IQR): 1.08 (0.98–1.17) m/s vs. 1.05 (0.94–1.15) m/s, P < 0.001] than those non-drinkers, while female drinkers had higher gait speed [median (IQR): 1.02 (0.94–1.11) m/s vs. 0.99 (0.89–1.09) m/s, P = 0.031] than those non-drinkers. Multivariate logistic regression showed that in older adults younger than 85 years, both interim drinking (RR = 0.60; 95%CI = 0.39–0.93; P = 0.021 for males; RR = 0.36; 95%CI = 0.13–0.90; P = 0.035 for females) and daily drinking (RR = 0.78; 95%CI = 0.61–0.99; P = 0.045 for males; RR = 0.34; 95%CI = 0.12–0.96; P = 0.041 for females) were correlated with decreased risk of sarcopenia even after adjustment for confounding factors. However, our dose-response analysis did not show any significant relationship between daily alcohol intake and the risk of sarcopenia as well as the components of sarcopenia. In conclusion, our results indicated that alcohol drinking may not be a risk factor for sarcopenia in the older adults. Further research will help to understand the underlying mechanism of the observed causal relationship.

Objective: This study evaluated the efficacy of Symptom-Oriented Mind Mapping combined with Problem-Based Learning (SOM-PBL) in intensive care unit (ICU) clinical clerkships, assessing its impact on medical students’ knowledge integration, clinical decision-making efficiency, and procedural skills, thereby providing theoretical and practical insights for optimizing critical care medical education.Methods: A prospective randomized controlled trial enrolled 160 fifth-year medical students during ICU clerkships at the Fourth Affiliated Hospital of Nanjing Medical University (January 2023–December 2024). Participants were randomly assigned to the SOM-PBL group (n = 80) or the control group (n = 80) using stratified randomization based on academic major and pre-clerkship academic performance. All students subsequently completed a four-week ICU clerkship using their assigned instructional method (SOM-PBL or traditional teaching), after which they underwent comprehensive assessments in theoretical knowledge, procedural skills, clinical reasoning, and educational satisfaction.Results: The SOM-PBL group achieved significantly higher median knowledge theoretical scores [median (IQR): 77 (73, 80) vs. 74 (72, 77); p < 0.05] and superior clinical reasoning performance [median (IQR): 88 (85, 93) vs. 87 (84, 89.75); p < 0.05]. No significant intergroup difference was observed in procedural skills performance [median (IQR): 92 (90, 94) for both groups; p = 0.938]. SOM-PBL showed significant strengths in monitoring technology/device application, pathophysiology/disease recognition, and diagnostic cognitive rigor (all p < 0.05). Over 80% of SOM-PBL students rated ≥90% of survey items as 4 or 5 on a 5-point Likert scale, indicating high satisfaction with learning efficiency, engagement, clinical reasoning enhancement, and course quality.Conclusion: The study demonstrated that the SOM-PBL approach significantly enhanced medical students’ knowledge integration and clinical decision-making efficiency during ICU clerkships. However, no significant improvement was observed in procedural skills. These findings offer both theoretical and practical value for innovating critical care medical education by effectively addressing knowledge fragmentation and bridging the theory-practice gaps.