Background Large-for-gestational-age (LGA) births are associated with adverse perinatal outcomes and increased risks of offspring obesity, metabolic syndrome, and cardiovascular diseases later in life. Beyond traditional risk factors, exposure to environmental factors, especially fine particulate matter (PM_2.5), before and during pregnancy may contribute to excessive fetal growth; however, the roles of specific chemical constituents and critical exposure windows remain unclear. Objective To examine the associations between maternal exposures to PM_2.5 and its chemical constituents before and during pregnancy and the risk of delivering LGA infants. Methods Singleton pregnancies from the National Free Preconception Health Examination Project between 2010 and 2014 were included. Individual exposures to PM_2.5 and its constituents were estimated for preconception and pregnancy windows using geocoded residential addresses. The associations of single and mixed exposures with LGA risk were analyzed using generalized linear models (GLMs) and qg-computation. Results Exposures to PM_2.5 and its major chemical constituents were significantly associated with an increased LGA risk, with differences in effect magnitude across components. Secondary inorganic aerosols showed the strongest associations. For full-pregnancy exposure, nitrate (OR=1.330, 95%CI: 1.313, 1.347), ammonium (OR=1.279, 95%CI: 1.263, 1.295), and sulfate (OR=1.242, 95%CI: 1.227, 1.257) had larger effects on LGA risk than black carbon and organic matter. Analysis by exposure window indicated that the month preceding conception and the third trimester of pregnancy were critical exposure windows for susceptibility, while the strongest effect was observed for full-pregnancy exposure, suggesting a cumulative effect over time. Mixed exposure analysis further showed that nitrate and sulfate consistently accounted for the main positive contributions across different time windows. Conclusion Maternal exposures to PM_2.5 and its chemical components before and during pregnancy are associated with an elevated LGA risk. Nitrate and sulfate show consistent and strong associations across pregnancy stages, underscoring the importance of component composition and exposure timing in fetal overgrowth.

The success of"New Medical Sciences"in higher education requires effective tools in evalua-ting students'performance in courses.Previously,we reported a teamwork(T),critique(C)and ap-preciation(A)(TCA)ideological and political model,a teaching model widely applied in Basic Medical courses.TCA is an abbreviation derived from Tricarboxylic Acid Cycle in Biochemistry as an analogy for nurturing the abilities of thinking and teamwork(T),critique(C)and appreciation(A),which hope-fully could provide students with moral norms for cognition,science and life.This paper further explores the tools to assess the educational outcomes of the TCA model,by which teachers can collect feedback and reflect on teaching quality and effectiveness.Addressing the challenges of individual differences in large classes,fragmented learning feedback,and the difficulty of measuring meta-cognition in educational evaluation,this study employs strategies of value-added assessment,matrix assessment and norm-transfer-able assessment to evaluate the TCA abilities from the aspects of thinking quality,thinking creativity,co-operation ability,iterative thinking,dialectical thinking and job responsibility.By modifying/using 18 e-valuation tools in Education and Psychology,we have established a rubric system composed of 30 primary indicators(with 11 newly designed,10 partly modified and 9 directly adopted),along with 49 secondary indicators and 98 tertiary indicators to enhance the feasibility of the evaluation process.This rubric sys-tem was applied to Biochemistry teaching among the five-year-program undergraduates at Air Force Medi-cal University.Specifically,thinking and teamwork are evaluated by creative works from"the magic bio-chemical-circle",while critiques are assessed in large classes under the guidance of basic and clinical teachers,coupled with appreciation measured by job responsibility in a task-driven virtual reality(VR)project.The results indicate that Biochemistry teaching not only accumulates knowledge in students,but also achieves the goals in nurturing values and cognition.The inclusion of creative performance evalua-tion,cooperative learning and clinical case studies,can enhance students'interpersonal skills,coopera-tion,quality of thinking,creative thinking,iterative thinking and dialectical thinking to varying degrees.TCA-based Biochemistry teaching has a long-lasting impact on character education,and is capable of in-ducing positive long-term changes in students'cognition and lifestyle.Taken together,with the help of this rubric system,teachers can promptly acknowledge the effectiveness of their teaching,thereby facilita-ting their teaching strategies.

This research aims to construct a stable epithelial cell senescence model for screening and e-valuation of senolytics.We explored the optimal conditions for doxorubicin-induced senescence of non-transformed epithelial cells MCF 10A,including the optimal induction concentration,the optimal inter-vention time,and the optimal senescence duration,and confirmed the feasibility of MCF 10A as an epi-thelial senescence model by multiple ways.The optimal condition for Doxorubicin-induced senescence of MCF 10A cells was treatment with 0.6 μmol/L Doxorubicin for 16 h to achieve the best senescence state on the 8th day.Under the optimal induction conditions,the positive rate of senescence-associated β-gal-actosidase(SA-β-gal)staining in the treated group reached 97％.At the same time,biochemical results of detecting the expression of mRNA,proteins,and immunofluorescence demonstrated that the expression levels of senescence-associated secretory phenotype(SASP),p16,p21 and p53 in the treated group were significantly higher than those in the control cells,and Lamin B1 was significantly decreased(P＜0.001),which were consistent with the specific characteristics of senescence.In summary,an epithelial senescence model was successfully induced in MCF 10A cells by Doxorubicin in this study,which will promote the screening of senolytics for senescent epithelial cells.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

As an important endocrine organ of human body,adipose tissue secrets a large amount of endocrine fac-tors that regulate a variety of physiological functions,and role of adiponectin in cardiovascular system is especially important.At the cellular and molecular level,adiponectin possesses profound anti-inflammatory,anti-oxidative and anti-apoptotic effects,which can reduce various pathogenic factors of cardiovascular diseases(CVD).In ad-vanced stage of CVD,the expression of adiponectin in adipose tissue as well as its circulating level compensatively increased.Therefore,adiponectin has a protective effect on the cardiovascular system,and increased adiponectin level may suggest severe CVD.In this review article,we systematically introduced the role of adiponectin in CVD and discussed its application prospects as a clinical biomarker.

Objective:To investigate the clinical efficacy of extended abdominal wall resec-tion combined with reconstruction for abdominal wall aggressive fibromatosis (AF).Methods:The retrospective and descriptive study was conducted. The clinical data of 70 patients with abdominal wall AF who were admitted to 3 medical centers, including The First Affiliated Hospital of the University of Science and Technology of China, between January 2009 and July 2024 were collected. There were 6 males and 64 females, aged (36±13)years. All patients underwent extended abdominal wall resection combined with abdominal wall reconstruction. Observation indicators: (1) surgical situations; (2) tumor recurrence and postoperative complications. Comparisons of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Results:(1)Surgical situations. All 70 patients underwent extended abdominal wall resection combined with abdominal wall recons-truction. The operation time was 90(91)minutes and duration of postoperative hospital stay was 10(6)days. Of the 70 patients, 41 patients underwent abdominal wall AF resection plus polypropylene mesh abdominal wall reconstruction, with a defect area of 60(54)cm2. The mesh placement method was uniformly Sublay repair. The remaining 29 patients underwent abdominal wall AF resection plus direct suture repair, with a defect area of 34(31)cm2. There was a significant difference in the abdominal wall defect area between the two groups ( U=291.00, P<0.05). All 70 patients achieved R 0 resection. The distance from surgical margin to tumor edge was 2-3 cm in 39 cases and >3 cm in 31 cases. (2) Tumor recurrence and postoperative complications. All 70 patients were followed up for 78(90)months. During follow-up, 10 patients developed tumor recurrence (5 cases with mesh reinforced abdominal wall reconstruction and 5 cases with direct suture repair). Among them, one case was monitored, one case underwent radiotherapy, and neither received further surgical treatment. The remaining 8 patients underwent repeat R 0 resection, and no further recurrence occurred. There was no significant difference in recurrence rate between the patients with mesh reconstruction and patients with direct suture repair ( χ2=0.06, P>0.05). The postoperative recurrence rate was 9.7%(3/31) in patients with the distance from surgical margin to tumor edge >3 cm, versus 17.9%(7/39) in patients with the distance from surgical margin to tumor edge of 2-3 cm, showing no significant difference between them ( χ2=0.97, P>0.05). Sixty patients had no tumor recurrence. During follow-up, none of the 70 patients developed incisional hernia. Two patients experienced postoperative wound infection, and 6 cases developed postoperative chronic pain. Conclusion:Extended abdominal wall resection combined with reconstruction is safe and feasible for abdominal wall AF.

Artificial intelligence (AI) integrated with time-lapse (TL) imaging for embryo selection significantly minimizes subjectivity and workload in traditional methods, marking a pivotal advancement in the realm of assisted reproductive technology. This review comprehensively summarizes the representative studies conducted in recent years within these domains and delves into the application of AI combined with TL imaging for embryo selection from three perspectives: data selection, model selection, and model evaluation. While AI research has yet to fully achieve automated embryo selection, it has already commenced assisting embryologists in annotating and selecting embryos to a considerable extent, thereby reducing subjective discrepancies and easing the workload. Existing software for oocyte quality scoring, embryo ploidy prediction, and transfer outcome forecasting has exhibited promising performance in studies. However, there remains an ongoing need for the development of high-quality datasets and the conduct of prospective, multicenter studies with large sample sizes across diverse devices. The evolution of AI combined with TL imaging in the field of embryo selection merits heightened attention from both clinicians and embryologists.

The phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin(PI3K/Akt/mTOR)signaling pathway plays a crucial role in the regulation of renal fibrosis by participating in inflammatory response,oxidative stress and autophagy.Paeoniflorin exhibits remarkable efficacy in treating myocardial and liver fibrosis.This article provides a comprehensive review on the research progress of paeoniflora in preventing and treating renal fibrosis through modulation of the PI3K/Akt/mTOR signaling pathway,offering novel insights for traditional Chinese medicine-based approaches to prevent and treat renal fibrosis.

BACKGROUND:The traditional method for treating infected bone defects is thorough debridement,filling with antibiotic-impregnated bone cement,and then autologous bone transplantation.However,there are problems such as insufficient antibiotic concentration and drug resistance,and limited bone mass.Therefore,it is of great clinical significance to seek dual-functional biomaterials that can locally release antibiotics at the site of infection and promote bone repair.OBJECTIVE:To design an injectable hydrogel composed of hyaluronic acid and oxidized dextran as a local delivery system for vancomycin to treat infection and promote bone regeneration.METHODS:(1)Vancomycin-loaded hyaluronic acid/oxidized dextran hydrogels were prepared to characterize the morphology,mechanical properties,and in vitro drug release of the hydrogels.(2)Hyaluronic acid/oxidized dextran hydrogels and vancomycin-loaded hyaluronic acid/oxidized dextran hydrogels were co-cultured with rabbit bone marrow mesenchymal stem cells.Cell activity and proliferation were detected by live-dead staining and CCK-8 assay.After osteogenic induction,alkaline phosphatase staining,alizarin red staining,RUNX2 immunofluorescence staining,and RT-qPCR detection(osteocalcin and bone morphogenetic protein 2 mRNA expression)were performed to evaluate the osteogenic differentiation of rabbit bone marrow mesenchymal stem cells.(3)The above two hydrogels were co-cultured with Escherichia coli(or Staphylococcus aureus)to detect the antibacterial ability of the hydrogels.(4)Thirty rabbits were selected to establish a 1.5 cm infected bone defect model in the middle of the left radius.Two weeks after modeling,they were randomly divided into three intervention groups:the blank group(n=10)did not receive any treatment;the control group(n=10)was injected with hyaluronic acid/oxidized dextran hydrogel at the bone defect site;the experimental group(n=10)was injected with vancomycin-loaded hyaluronic acid/oxidized dextran hydrogel at the bone defect site.12 weeks after injection,the samples were collected for Micro-CT scanning,tissue morphology observation,RT-qPCR detection(tumor necrosis factor α,interleukin 6 mRNA expression),and immunohistochemical staining.RESULTS AND CONCLUSION:(1)Vancomycin-loaded hyaluronic acid/oxidized dextran hydrogel had a good porous structure with a pore size between 100-300 μm,and had good mechanical properties and in vitro drug sustained release performance.(2)Live-dead staining and CCK-8 assay results confirmed that vancomycin-loaded hyaluronic acid/oxidized dextran hydrogel had good biocompatibility.Alkaline phosphatase staining,alizarin red staining,RUNX2 immunofluorescence staining,and RT-qPCR test results showed that both hydrogels could promote osteogenic differentiation of rabbit bone marrow mesenchymal stem cells.(3)Compared with hyaluronic acid/oxidized dextran hydrogel,vancomycin-loaded hyaluronic acid/oxidized dextran hydrogel could significantly inhibit the growth of Escherichia coli and Staphylococcus aureus.(4)Micro-CT scanning results showed that the bone volume fraction and bone density of new bone in the bone defect area of the experimental group were higher than those of the blank group and the control group(P＜0.05).The bone tissue morphology observation results showed that the experimental group had better repair effect of bone defects compared with the blank group and control group.The expression of tumor necrosis factor α and interleukin 6 mRNA in the bone defect site in the experimental group was lower than that in the blank group and control group(P＜0.05).Immunohistochemical staining showed that the protein expressions of osteocalcin and RUNX2 at the site of bone defects in the experimental group and control group were higher than those in the blank group(P＜0.05).These findings indicate that vancomycin-loaded hyaluronic acid/oxidized dextran hydrogel can effectively promote bone regeneration under infection.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.