Metabolic associated fatty liver disease (MAFLD) is fundamentally driven by an imbalance in hepatic fatty-acid flux: the influx of fatty acids exceeds the liver’s capacity for disposal, resulting in excessive hepatic lipid accumulation, predominantly in the form of triglycerides (TGs). The occurrence and progression of MAFLD depend on disordered regulation across multiple metabolic steps, including fatty-acid uptake, de novo lipogenesis (DNL), fatty-acid oxidation (FAO), and very low-density lipoprotein (VLDL) export. Forkhead box protein O1 (FOXO1) is a key transcriptional regulator within the hepatic network coordinating glucose and lipid metabolism. Under metabolic stress and insulin resistance (IR), FOXO1 expression is frequently increased, whereas its inhibitory phosphorylation is reduced. These changes enhance FOXO1 nuclear localization and transcriptional activity, thereby reprogramming the expression of genes related to metabolism in the liver. Because hepatic lipid deposition is the central pathological feature of MAFLD, the functional status of FOXO1 directly influences hepatic lipid homeostasis. Growing evidence suggests that FOXO1 can exert bidirectional, environment-dependent effects on hepatic lipid accumulation; however, the molecular basis for this functional switch remains incompletely understood. This review systematically summarizes the biological functions and regulatory mechanisms of FOXO1 and its roles in hepatic lipid metabolism, with a particular focus on its crosstalk with insulin signaling. FOXO1 expression is shaped by RNA modifications and epigenetic regulation mediated by non-coding RNAs. Its transcriptional output is precisely governed by post-translational modifications—such as phosphorylation and acetylation—as well as by coordinated nucleocytoplasmic shuttling. Notably, these regulatory patterns vary markedly across nutritional states, degrees of insulin resistance, and stages of disease. In the fed state, insulin/IGF-1 signaling activates the PI3K-AKT pathway, promoting the inhibitory phosphorylation of FOXO1 and facilitating additional modifications, including acetylation, methylation, and ubiquitination. Together, these events drive FOXO1 export from the nucleus and dampen its transcriptional activity, suppressing gluconeogenesis and constraining lipogenic programs. Conversely, during fasting or when insulin signaling is weakened, FOXO1 inhibition is relieved. FOXO1 accumulates in the nucleus, binds to DNA, and regulates the transcription of downstream target genes. Mechanistically, FOXO1 can aggravate hepatic lipid accumulation by activating genes involved in TG synthesis while repressing FAO-related pathways, thereby favoring storage over oxidation. However, under specific conditions, FOXO1 may also alleviate the hepatic lipid burden by promoting TG hydrolysis and enhancing VLDL secretion, thereby reducing the net hepatic lipid load. In addition, lipotoxic signals mediated by ceramides and diacylglycerols (Cer/DAG) activate atypical protein kinase C (aPKC), further exacerbating the disruption of the AKT-FOXO1 axis. This vicious cycle ultimately produces a metabolic paradox in which increased hepatic glucose output coexists with persistent, insulin-independent lipogenesis, accelerating MAFLD progression. Importantly, FOXO1 regulation is not uniform: during early metabolic overload, insulin-mediated suppression may remain effective, whereas in advanced insulin resistance, the loss of AKT control permits sustained FOXO1 activity. Such stage-dependent dynamics may help explain why FOXO1 can either promote steatosis or, in certain contexts, support programs that facilitate lipid turnover. Accordingly, interventions should be liver-specific and tuned to the disease stage, aiming to curb maladaptive FOXO1 signaling while preserving its capacity to promote triglyceride hydrolysis and VLDL secretion when advantageous. Overall, this review offers an important perspective on MAFLD pathogenesis, emphasizing FOXO1 as a potential therapeutic target and providing a theoretical basis for developing liver-specific, disease-course-dependent precision interventions.

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection that rarely involves the periorbital region. We report an unusual case of periorbital NF caused by methicillin-sensitive Staphylococcus aureus (MSSA) in a previously healthy 48-year-old woman, originating from a neglected, recurrent hordeolum—an otherwise benign eyelid condition. The infection resulted in an extensive fullthickness defect of the upper eyelid and adjacent temporal area, presenting major reconstructive challenges. Reconstruction was performed using a radial forearm free flap combined with a buccal mucosal graft to restore both anterior and posterior lamellae, achieving functional eyelid protection and improved visual acuity. This case highlights the potential for seemingly minor, recurrent eyelid infections to progress rapidly to devastating NF even in the absence of systemic symptoms or risk factors. Early recognition and multidisciplinary management were critical to preventing further morbidity. To our knowledge, MSSA has not previously been reported as a causative agent of periorbital NF, underscoring the need for clinical vigilance and timely intervention in common eyelid conditions to avoid catastrophic complications.

Objective To analyze the incidence rate and risk factors of atrial fibrillation (AF) in elderly patients with chronic obstructive pulmonary disease (COPD). Methods A total of 392 patients with COPD in the hospital were selected from December 2020 to December 2024. Patients' data (medical history, echocardiographic data, etc.) were recorded. The incidence rate of AF in patients was recorded and the patients were grouped according to whether or not they developed AF. The differences were compared between the two groups, and the risk factors of AF occurrence in elderly patients with COPD were analyzed. Results Among the 392 patients with COPD, 127 cases (32.40%) met the diagnostic criteria of AF. There were statistically significant differences in age, pulmonary infection, heart failure, diabetes, smoking history, disease duration, LAD, severe renal insufficiency and coronary heart disease between the AF group and the non-AF group (P<0.05). Multivariate logistic regression analysis suggested that age, pulmonary infection, heart failure, diabetes mellitus, smoking history, disease course, LAD, severe renal insufficiency and coronary heart disease were all risk factors for elderly patients with COPD (OR=1.129, 4.246, 3.955, 4.125, 2.038, 1.112, 1.102, 4.397, and 3.865, P<0.05). Conclusion The incidence rate of AF is high in elderly patients with COPD. Age, pulmonary infection, heart failure, diabetes mellitus, smoking history, course of disease, LAD, severe renal insufficiency, and coronary heart disease are all risk factors for AF.

Laparoscopic subtotal cholecystectomy (LSC) has been a safe and viable alternative to conversion to laparotomy in cases of severe cholecystitis. The objective of this study is to determine the utility of intraoperative choledochoscopy in LSC for the exploration of the gallbladder, cyst duct, and subsequent stone clearance of the cystic duct in cases of severe cholecystitis. A total of 72 patients diagnosed with severe cholecystitis received choledochoscopy-assisted laparoscopic subtotal cholecystectomy (CALSC). A choledochoscopy was performed to explore the gallbladder cavity and/or cystic duct, and to extract stones using a range of techniques. The clinical records, including the operative records and outcomes, were subjected to analysis. No LSC was converted to open surgery, and no bile duct or vascular injuries were sustained. All stones within the cystic duct were removed by a combination of techniques, including high-frequency needle knife electrotomy, basket, and electrohydraulic lithotripsy. A follow-up examination revealed the absence of residual bile duct stones, with the exception of one common bile duct stone, which was extracted via endoscopic retrograde cholangiopancreatography. In certain special cases, CALSC may prove to be an efficacious treatment for the management of severe cholecystitis. This technique allows for optimal comprehension of the situation within the gallbladder cavity and cystic duct, facilitating the removal of stones from the cystic duct and reducing the residue of the non-functional gallbladder remnant.

To investigate the effects of Biyan Jiedu Capsules on the proliferation and apoptosis of nasopharyngeal carcinoma cells and their molecular mechanism, nasopharyngeal carcinoma cells CNE1 and CNE2 were used. They were divided into control group(30% blank serum medium), low-(10% drug-containing serum + 20% blank serum medium), medium-(20% drug-containing serum + 10% blank serum medium), and high-(30% drug-containing serum medium) concentration group of Biyan Jiedu Capsules according to in vitro experiment. After 24 h of intervention, the effects of Biyan Jiedu Capsules on the proliferation of CNE1 and CNE2 were detected by CCK-8 assay, clonal formation experiment, and EdU staining. The effect of Biyan Jiedu Capsules on apoptosis of CNE1 and CNE2 was detected by flow cytometry. Western blot was used to detect the effect of Biyan Jiedu Capsules on the expression of X-linked apoptosis inhibitor protein(XIAP), survivin, proliferating cell nuclear antigen(PCNA), and PI3K/Akt pathway-related proteins in CNE1 and CNE2. The results showed that compared with the control group, the survival rate of CNE1 and CNE2 in the medium and high concentration groups of Biyan Jiedu Capsules could be decreased in a concentration-dependent way(P<0.05, P<0.01). At the same time, EdU staining and clonal formation experiments showed that the proliferation of CNE1 and CNE2 was significantly inhibited in the medium and high concentration groups of Biyan Jiedu Capsules(P<0.05, P<0.01). Flow cytometry showed that the apoptosis rate of CNE1 and CNE2 was significantly increased in all concentration groups of Biyan Jiedu Capsules(P<0.01), and the apoptosis rate was concentration-dependent. Western blot showed that the expressions of XIAP, survivin, PCNA, p-PI3K, and p-Akt in all concentration groups of Biyan Jiedu Capsules were significantly down-regulated(P<0.05, P<0.01). In conclusion, Biyan Jiedu Capsules can inhibit the proliferation and induce apoptosis of nasopharyngeal carcinoma cells possibly by down-regulating the PI3K/Akt signaling pathway.
Humans ; Apoptosis/drug effects* ; Cell Proliferation/drug effects* ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms/physiopathology* ; Proto-Oncogene Proteins c-akt/genetics* ; Cell Line, Tumor ; Drugs, Chinese Herbal/pharmacology* ; Phosphatidylinositol 3-Kinases/genetics* ; Signal Transduction/drug effects* ; Capsules ; Carcinoma/drug therapy*

Qualitative and quantitative analysis methods for chemical components of different processed products of Corni Fructus were established to systematically characterize and identify these components, and the content of the main differential components was determined. The chemical components of different processed products of Corni Fructus were collected using ultra-high performance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry(UPLC-Q-TOF-MS). Through analysis of self-built databases, literature, and reference standards, a total of 93 components were obtained, including 19 iridoids, 15 flavonoids, 16 organic acids, eight triterpenoids, eight tannins, four amino acids, two polysaccharides, five olefins, and 16 other compounds. Additionally, by using multivariate statistical methods, the differential components between different processed products of Corni Fructus were screened under the conditions of VIP>1.0 and FC<0.5 or FC>2.0 and P<0.05. The PCA and OPLS-DA results showed differences in the chemical components between different processed products of Corni Fructus. A total of 21 differential components were screened, including tartaric acid, morroniside, and rutin. On this basis, ultra-high performance liquid chromatography-triple quadrupole tandem mass spectrometry(UPLC-QqQ-MS/MS) was used to determine the content of 10 main common differential components, including gallic acid, morroniside, ursolic acid, loganin, swertiamarin, rutin, 5-hydroxymethylfurfural, cornuside Ⅰ, quercetin, and oleanolic acid. The above 10 components showed a good linear relationship within the determined concentration range, with the precision, stability, repeatability, and sample recovery rate all meeting the requirements. Compared with that in Corni Fructus, the content of iridoid glycosides in wine-prepared Corni Fructus and wine-and honey-prepared Corni Fructus decreased, while the content of gallic acid, rutin, quercetin, 5-hydroxymethylfurfural, ursolic acid, and oleanolic acid increased. Compared with wine-prepared Corni Fructus, wine-and honey-prepared Corni Fructus showed varying degrees of increase in all other components, except for a slight decrease in gallic acid content. In summary, this study clarified the influence of different processing methods on the chemical components of Corni Fructus, providing a theoretical basis for the scientific connotation, overall quality evaluation, and clinically rational application of Corni Fructus processing in the future.
Tandem Mass Spectrometry/methods* ; Chromatography, High Pressure Liquid/methods* ; Cornus/chemistry* ; Drugs, Chinese Herbal/chemistry* ; Fruit/chemistry*

OBJECTIVES: To investigate the current status and influencing factors of sleep disorders in school-age children with asthma, providing a scientific basis for improving sleep quality and quality of life of asthmatic children. METHODS: This study selected school-age children with asthma admitted to the Children's Hospital of Nanjing Medical University from March 2022 to March 2024 as subjects. A questionnaire was used to assess their sleep conditions, and based on the assessment results, the participants were divided into a sleep disorder group (106 children) and a non-sleep disorder group (181 children). Multivariate logistic regression analysis was conducted to identify the influencing factors of sleep disorders in asthmatic children. RESULTS: A total of 287 asthmatic children were included, of which 106 (36.9%) had sleep disorders. Multivariate logistic regression analysis showed that being older than 10 years, obesity, poor medication adherence, unhealthy family functioning, passive smoking, and participation in only some physical activities were all risk factors for sleep disorders in school-aged children with asthma (P<0.05). CONCLUSIONS The incidence of sleep disorders in school-age children with asthma is relatively high and influenced by multiple factors, including age, obesity, poor medication adherence, unhealthy family functioning, passive smoking, and limited participation in physical activities. To improve the sleep quality and quality of life of asthmatic children, corresponding intervention measures should be implemented targeting these influencing factors.
Humans ; Asthma/complications* ; Child ; Male ; Female ; Sleep Wake Disorders/etiology* ; Logistic Models ; Quality of Life ; Adolescent ; Risk Factors

Objective To compare the clinical efficacy of using edaravone dexmedetomidine at different times after intravenous thrombolysis in elderly patients with acute ischemic stroke(AIS).Methods A prospective study was conducted on 180 elderly AIS patients undergoing intravenous thrombolysis with recombinant tissue-type plasminogen activator in our department from April 2022 to December 2023.The patients were randomly divided into immediate group,12 h group and 24 h group,receiving an edaravone dexmedetomidine injection immediately and at 12 and 24 h after thrombolysis,respectively.During the study period,2 cases were excluded from both the immediate group and the 24 h group.NIHSS and MMSE were used to assess neurological function and cognitive function.The levels of TNF-α,IL-6 and hs-CRP were detected.The occurrence of complications after thrombolytic therapy was recorded in the three groups.Results The NIHSS scores of the three groups were significantly lower at 7 d after thrombolysis and 3 months after discharge than those before thrombolysis(P＜0.05).The scores of the immediate group were obviously lower than those of the 12 h and 24 h groups 7 d after thrombolysis,and 3 months after discharge,and the scores of the 12 h group were significantly lower than that of the 24 h group at 3 months after discharge(P＜0.05).The MMSE scores were significantly higher in the three groups at 7 d after thrombolysis and 3 months after discharge than before thrombolysis(P＜0.05).The MMSE scores of the immediate group were significantly higher than those of the 12 h and 24 h groups at 7 d after thrombolysis,and 3 months after discharge(P＜0.05),and the MMSE scores of the 12 h group were significantly higher at 7 d after thrombolysis,and 3 months after discharge than those of the 24 h group(P＜0.05).At 7 d after thrombolysis,the levels of TNF-α,IL-6,and hs-CRP were significantly decreased in the three groups than before thrombolysis(P＜0.05),and the levels were notably lower in the immediate group than the 12 h and 24 h groups,and in the 12 h group than the 24 h group(P＜0.05).The incidence of complications was significantly lower in the immediate group than the 12 and 24 h groups(P＜0.05).At 3 months after discharge,good prognosis was observed in 22 cases(37.93％)from the immediate group,11 cases(18.33％)from the 12 h group,and 10 cases(17.24％)from the 24 h group,and the rate of good prognosis was significantly higher the immediate group than the other two groups(x2 three groups=8.558,x2 immediate group vs.12h group=4.623,x2 immediate group vs.24h group=6.214,P＜0.05).Conclusion Immediately using edaravone dexmedetomidine as adjuvant therapy for AIS after thrombolysis is more effective than using in 12 and 24 h after thrombolysis,which can significantly attenuate inflammatory reactions,better restore neurological and cognitive functions,reduce the occurrence of complications,and improve their short-term prognosis.

Zirconium dioxide(ZrO2)is a suitable solid phase microextraction(SPME)fiber coating due to its high thermal and chemical stability and excellent adsorption.Similarly,polydopamine(PDA)can also be utilized as SPME fiber coating because of its strong oxidation resistance and stability,desired adsorption as well as environmental friendliness.In this work,a novel zirconium dioxide-doped polydopamine(ZrO2@PDA)SPME fiber coating was quickly fabricated on the stainless steel(SS)by cyclic voltammetry(CV)using the etched SS wire as working electrode,a Pt rod as counter electrode and a saturated calomel electrode as reference electrode.Coupled with high performance liquid chromatography-ultraviolet detection(HPLC-UV),the extraction performance of the fabricated SS@ZrO2@PDA fiber was evaluated using typical aromatic compounds of polycyclic aromatic hydrocarbons(PAHs),ultraviolet filters(UvFs),phthalate acid esters(PAEs)and chlorophenols(CPs).The SS@ZrO2@PDA fiber showed excellent extraction capability for PAHs and PAEs,however,poor extraction capability for UvFs and no extraction capability for CPs.Therefore,PAHs were selected as target analytes and the key experimental factors on extraction efficiency were optimized.Under the optimized conditions,good linearity was obtained for the developed SPME-HPLC-UV method with the SS@ZrO2@PDA fiber.The limits of detection(LODs,S/N=3)were 0.018-0.082 μg/L.The developed method was successfully applied to determination of trace PAHs in different actual water samples with recoveries of 86.7%-102.4%and RSDs less than 8.2%.In addition,the fabricated novel fiber was simple to prepare and exhibited high stability,good reproducibility and long service life.