Background Exposure to polycyclic aromatic hydrocarbons (PAHs) is associated with the development of metabolic syndrome (MS). However, the role of amino acids in PAH-induced MS remains unclear. Objective To explore the impact of PAHs exposure on the incidence of MS among coking workers, and to determine potential modifying effect of amino acid on this relationship. Methods Unmatched nested case-control design was adopted and the baseline surveys of coking workers were conducted in two plants in Taiyuan in 2017 and 2019, followed by a 4-year follow-up. The cohort comprised 667 coking workers. A total of 362 participants were included in the study, with 84 newly diagnosed cases of MS identified as the case group and 278 as the control group. Urinary levels of 11 PAH metabolites and plasma levels of 17 amino acids were measured by ultrasensitive performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Logistic regression was used to estimate the association between individual PAH metabolites and MS. Stratified by the median concentration of amino acids, Bayesian kernel machine regression (BKMR) model was employed to assess the mixed effects of PAHs on MS. Due to the skewed data distribution, all PAH metabolites and amino acids in the analysis were converted by natural logarithm ln (expressed as lnv). Results The median age of the 362 participants was 37 years, and 83.2% were male. Compared to the control group, the case group exhibited higher concentrations of urinary 2-hydroxyphenanthrene (2-OHPhe), 9-hydroxyphenanthrene (9-OHPhe), and hydroxyphenanthrene (OHPhe) (P=0.005, P=0.049, and P=0.004, respectively), as well as elevated levels of plasma branched chain amino acid (BCAA) and aromatic amino acid (AAA) (P<0.05). After being adjusted for confounding factors, for every unit increase in lnv_2-OHPhe in urine, the OR (95%CI) of MS was 1.57 (1.11, 2.26), and for every unit increase in lnv_OHPhe, the OR (95%CI) of MS was 1.82 (1.16, 2.90). Tyrosine, leucine, and AAA all presented a significant nonlinear correlation with MS. At low levels, tyrosine, leucine, and AAA did not significantly increase the risk of MS, but at high levels, they increased the risk of MS. In the low amino acid concentration group, as well as in the low BCAA and low AAA concentration groups, it was found that compared to the PAH metabolite levels at the 50th percentile (P₅₀), the log-odds of MS when the PAH metabolite levels was at the 75th percentile (P₇₅) were 0.158 (95%CI: 0.150, 0.166), 0.218 (95%CI: 0.209, 0.227), and 0.262 (95% CI: 0.241, 0.282), respectively, However, no correlation between PAHs and MS was found in the high amino acid concentration group. Conclusion Amino acids modify the effect of PAHs exposure on the incidence of MS. In individuals with low plasma amino acid levels, the risk of developing MS increases with higher concentrations of mixed PAH exposure. This effect is partly due to the low concentrations of BCAA and AAA.

Objective To investigate the factors affecting the hemorrhagic transformation(HT)and symptomatic intracranial hemorrhage(sICH)in patients with acute ischemic stroke due to large vessel occlusion(AIS-LVO)of anterior circulation after receiving endovascular treatment(EVT).Methods A total of 193 patients with AIS-LVO of anterior circulation,who were admitted to the Neurology Department of Anyang Municipal People's Hospital of China from January 2023 to November 2024,were enrolled in this study.There were 84 patients in the HT group and 42 patients in the sICH group.The baseline and clinical data,including gender,age,vascular risk factors(history of hypertension,diabetes,coronary artery disease,atrial fibrillation,coronary stent implantation,valve replacement,smoking),stroke history,pre-operative National Institutes of Health Stroke Scale(NIHSS)scores,laboratory indicators(preoperative D-dimer,neutrophil count,lymphocyte count,postoperative total CO2,and CO2 partial pressure),and perioperative indicators(procedure duration,surgical approach,anesthesia type,and preoperative intravenous thrombolysis),were collected.The clinical data were compared between non-HT group and HT group,as well as between non-sICH group and sICH group,and the independent risk factors for HT and sICH after receiving EVT treatment for AIS-LVO of anterior circulation were analyzed.Results The differences in coronary heart disease(x2=8.443,P=0.004),D-dimer(Z=-3.59,P＜0.001),preoperative NIHSS score(Z=-3.752,P＜0.001),surgical time(Z=-2.529,P=0.011),lesion site(x2=9.951,P=0.019),and moderate to severe stenosis or occlusion of other blood vessels(P=0.025)between the HT group and the non-HT group were statistically significant.The differences in the other baseline indicators and clinical data were not statistically significant(all P＞0.05).The multivariate logistic regression analysis showed that preoperative NIHSS score(OR=1.065,95％CI:1.021-1.110,P＜0.003),tandem lesions(OR=2.805,95％CI:1.306-6.024,P=0.008),coronary heart disease(OR=2.963,95％CI:1.421-6.174,P=0.004),and operation time(OR=1.009,95％CI:1.001-1.016,P=0.019)were the independent risk factors for HT after EVT.No statistically significant differences in baseline data,occlusion site,coexisting other vascular stenosis,and perioperative related indicators existed between the sICH group and the non-sICH group.Conclusion Preoperative NIHSS score,tandem lesion,coronary artery disease,and operation time are the independent risk factors for HT in patients with AIS-LVO of the anterior circulation after receiving EVT.

Leukemia is a malignant proliferative tumor that seriously endangers the quality of life of patients. In recent years, new research achievements have been made on the pathogenesis of leukemia, and some progresses of various drugs targeting the hypoxic microenvironment of leukemia have been made. This article reviews the progress of drugs targeting hypoxia microenvironment to treat leukemia from the aspects such as reactive oxygen species associated with anoxic microenvironment, hypoxia inducible factor, CXC chemokine receptor and vascular endothelial growth factor.

In patients with Graves′ disease, repeated transition between hyperthyroidism and hypothyroidism is uncommon. This report describes a female Graves′ disease patient with persistently high levels of thyroid-stimulating hormone receptor antibodies, who experienced multiple transitions between hyperthyroidism and hypothyroidism over a 7-year follow-up period, including during pregnancy. The fluctuations may be linked to the interplay between thyroid-stimulating hormone receptor stimulating antibody(TSAb) and thyroid-stimulating hormone receptor blocking antibody(TBAb). Treatment with either antithyroid medications or levothyroxine sodium, based on the patient′s thyroid status, helped maintain normal thyroid function. Stable thyroid function may contribute to maintaining a consistent thyroid immune status and reducing thyroid function fluctuation.

Maternal high titers of thyroid stimulating hormone receptor antibody(TRAb) during pregnancy can cause fetal and neonatal thyroid dysfunction, among which hypothyroidism is relatively rare. In this case, the woman was diagnosed with Hashimoto′s hypothyroidism prior to pregnancy and was treated with levothyroxine(LT 4) to maintain normal thyroid function throughout gestation. Despite normal maternal thyroid function, TRAb levels remained persistently elevated during pregnancy. The fetus showed a normal fetal thyroid circumference and heart rate, but no secondary ossification center was observed at 37 + 6 weeks of gestation. On the 9th day after birth, the neonate was diagnosed with congenital hypothyroidism and started on LT 4 replacement therapy. By 7 months of age, thyroid function had normalized, and LT 4 was discontinued. This case highlights the importance of close monitoring of fetal growth and neonatal thyroid function in pregnant women with high TRAb titers, to ensure timely detection and management of fetal and neonatal thyroid dysfunction.

This paper reported a type 1 diabetes patient who had severe diabetic nephropathy, retinopathy, hypertension, and hypothyroidism before pregnancy. The patient's blood glucose control was poor before pregnancy, and the complications were not properly treated. This was an unintended pregnancy, with a pre-pregnancy glycated hemoglobin A1c of 7.8% and early pregnancy urine protein of 3.81-4.53 g/24 h. Considering the patient's poor blood glucose control before pregnancy and the lack of proper treatment for multiple complications including nephropathy, a multidisciplinary consultation at an external hospital recommended termination of the pregnancy. However, the patient was determined to continue the pregnancy and was referred to Peking University First Hospital. Through strict blood glucose control, monitoring and evaluation of complications, and comprehensive management, the patient's blood glucose and blood pressure were well controlled during pregnancy. Regular monitoring of urine protein, renal function, and ocular fundus was conducted. At 31 weeks and 4 days of gestation, the patient's 24-hour urine protein significantly increased. After promoting fetal lung maturity, a cesarean section was performed at 34 weeks and 1 day of gestation, resulting in a successful delivery with good maternal and neonatal outcomes. At the 42-day postpartum follow-up, the patient's blood glucose and blood pressure were stable, urine protein returned to pre-pregnancy levels, and the infant was in good general condition.

Objective:To explore the surgical efficacy of cervical cerclage with cervical length (CL) <10 mm and emergency cerclage.Methods:From January 2013 to June 2022, a total of 98 singleton pregnant women who underwent ultrasound-indicated cervical cerclage because of CL<10 mm in the second trimester and underwent emergency cervical cerclage because of cervical dilation found by physical examination in Peking University First Hospital were enrolled. The differences in clinical data between the <34 weeks delivery group (25 cases) and the ≥34 weeks delivery group (73 cases) were compared. Meanwhile, according to different cervical status, they were divided into CL<10 mm group (43 cases) and cervical dilatation group (55 cases), and the cervical dilatation group was further divided into cervical dilatation <4 cm group and cervical dilatation ≥4 cm group. The clinical data and pregnancy outcomes of pregnant women with different cervical status were compared.Results:(1) There were significant differences in the proportion of preoperative CL<10 mm and the degree of preoperative cervical dilation between the <34 weeks delivery group and the ≥34 weeks delivery group (all P<0.05). (2) After cervical cerclage, compared with women in the cervical dilatation group, the prolonged gestational age in the CL<10 mm group was longer [(10.5±4.6) vs (14.3±3.4) weeks], the gestational age at delivery was later (median: 35.7 vs 38.0 weeks), the preterm birth rates before 37 and 34 weeks were lower, the late abortion rate was lower [9% (5/55) vs 0 (0/43)], and the newborn birth weight was higher, the differences were statistically significant (all P<0.05). (3) Compared with the cervical dilation ≥4 cm group, the prolonged gestational age of the cervical dilatation <4 cm group was longer [(7.5±5.3) vs (11.1±4.2) weeks], the gestational age at delivery was later (median: 29.2 vs 36.0 weeks), and the birth weight of the newborn was higher (all P<0.05). The late abortion rate of cervical dilatation <4 cm group was lower than that of cervical dilatation ≥4 cm group [7% (3/45) vs 2/10; P=0.220]. Conclusions:Timely cervical cerclage in individuals with CL<10 mm could reduce preterm birth rate before 34 weeks gestation, and the pregnancy outcome is better than that of individuals with cervical dilation. Moreover, the pregnancy outcome of cervical cerclage in women with cervical dilation <4 cm is significantly better than that in women with cervical dilatation ≥4 cm.

For women with type 1 diabetes mellitus (T1DM) reaching reproductive age, the disease course generally protracted, often accompanied by varying degrees of microvascular complications. Hence, the need for preconception planning and comprehensive screening and management of complications is urgent to avoid serious maternal and fetal complications. The recommended preconception glycated hemoglobin control target is currently set at<6.5%. In cases of unintended pregnancies where pre-existing microvascular complications are present, multidisciplinary standardized management during the pregnancy is essential. Although a multidisciplinary expert consensus on gestational management of T1DM has been published in China in 2020, several issues remain regarding the clinical management of T1DM in pregnancy across the nation. Strengthening nutritionally balanced management, actively and reasonably utilizing insulin therapy, and leveraging new technologies such as the internet plus artificial intelligence hold promise to achieve more optimal glucose control, reduce the incidence of maternal and fetal complications associated with T1DM, and ultimately achieve favorable outcomes for both mother and child.

American Aiabetes Association (ADA) updated the "Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2025" based on the latest medical evidence. The main points of this updated guideline include the preconception counseling section, the continuous glucose monitoring part in the glycemic goals in pregnancy section, the nutritional counseling part and automated insulin delivery systems part in the management of diabetes in pregnancy section, and the use of lipid-lowering drugs medications and statins therapy part in the pregnancy and drug considerations section. This article provides a detailed introduction and interpretation of the updated guidelines, in order to provide a reference for clinical practice.