ObjectiveTo investigate the effects and potential mechanisms of morning and evening fasting on postprandial lipid responses, a post hoc analysis based on a crossover randomized controlled trial was conducted to assess the effects of different fasting strategies on postprandial lipid metabolism in community residents in Shanghai. MethodsA total of 23 participants took part in a randomized crossover trial involving two intervention days: morning fasting and evening fasting, with a washout period of 6 days between intervention days. Two-way analysis of variance was used to test the differences in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and the relative expression of circadian clock genes before and after the next meal under fasting. Wilcoxon rank sum tests were used to analyze the different metabolites between the two groups. Principal component analysis and Orthogonal partial least squares-discriminant analysis were conducted to evaluate the ability of metabolites to differentiate between morning fasting and evening fasting and identify the important differential metabolites. After adjusting for age, sex, and BMI, a partial correlation analysis was performed to identify metabolites associated with plasma lipids. In addition, important metabolites associated with plasma lipids were computed by pathway enrichment analysis. ResultsAfter evening fasting intervention, fasting TG level [(0.37±0.29) vs (0.27±0.18)] mmol·L^-1, fasting and postprandial change values in TC [(2.74±0.47) vs (2.51±0.27)] mmol·L^-1 and LDL-C [(1.32±0.38) vs (0.99±0.27)] mmol·L^-1 were significantly lower than those after morning fasting (P<0.05). While, change values of fasting LDL-C [(0.89±0.37) vs (1.14±0.37)] mmol·L^-1 and TG [(1.14±0.19) vs (1.28±0.17)] mmol·L^-1 were significantly higher than those after morning fasting intervention (P<0.05). After fasting intervention, the relative expression of AMPK, CRY1, CLOCK, MTNR1B, AANAT, and ASMT was correlated with the amount of plasma lipid changes (P<0.05). Specifically, CLOCK and AANAT were upregulated following evening fasting and downregulated after morning fasting. Among the 217 important differential metabolites, 111 were correlated with plasma lipids, and which were primarily enriched in the cysteine and methionine metabolism pathways (P<0.05). ConclusionCompared to morning fasting, evening fasting was more effective in improving postprandial lipid responses, indicating that an evening fasting window during intermittent fasting could be conducive to cardiovascular disease prevention in adults. Meanwhile, it is suggested that morning and evening fasting may affect lipid responses through circadian rhythm oscillations and the cysteine and methionine metabolism pathways.

Acute-on-chronic liver failure (ACLF) is an acute deterioration of liver function occurring on the basis of chronic liver disease, accompanied by failure of the liver and extrahepatic organs, and is associated with a high short-term mortality rate. Liver transplantation is the only curative treatment for patients with ACLF. However, the shortage of donor livers and limitations of the organ allocation system mean that only a minority of patients can receive transplants. The current organ allocation system based on the model for end-stage liver disease (MELD) score may underestimate the urgency of liver transplantation for ACLF patients. Therefore, it is urgent to develop better assessment tools to determine which ACLF patients are most likely to benefit from liver transplantation. This article reviews the current mainstream definitions of ACLF, the selection of candidates for liver transplantation in ACLF, and the prognostic scoring systems for liver transplantation in ACLF, both domestically and internationally, in order to provide a reference for the prognostic assessment of liver transplantation in ACLF patients.

"Stagnation" is an important pathological state in the development and progression of malignant tumors. However， its intrinsic connection with different stages of tumor evolution has not been clearly elucidated in previous studies. Drawing on clinical practice， this paper proposes the theory of stagnant toxin， emphasizing stage-specific pathogenesis and differentiated treatment strategies for tumors based on the varying manifestations of stagnation at each phase. The theory interprets the pathogenesis of stagnant toxin across the stages of tumor development through the five elements "wood， fire， earth， metal， and water" corresponding respectively to wood stagnation in the precancerous stage， metal stagnation in the postoperative phase， fire stagnation during adjuvant therapy， earth stagnation in the progressive stage， and water stagnation in the advanced stage. Each type of stagnation reflects a distinct pathogenic mechanism， such as wood stagnation giving rise to disease， metal stagnation inducing residual symptoms， fire stagnation resulting in ulceration， earth stagnation spreading toxin transmission， and water stagnation leading to critical deterioration. Accordingly， the treatment principles include guiding wood stagnation with counterflow， dispersing metal stagnation to harmonize symptoms， venting fire stagnation to regress ulcers， depleting earth stagnation to block progression， and controlling water stagnation to preserve vitality. This theoretical framework offers a traditional Chinese medicine perspective for understanding and treating malignant tumors based on the concept of stagnant toxin.

Objective To study the expression of PLA2G2A and its significance in vaginal wall tissue of patients with pelvic organ pro-lapse(POP).Methods Twenty-three patients without POP(control group)and 26 patients with POP(POP group)admitted to the Third Affiliated Hospital of Zhengzhou University,between June 2023 and September 2024,were selected.Histological features were observed using hematoxylin and eosin and Masson's trichrome staining.Localization of PLA2G2A was detected using immunofluorescence.The PLA2G2A expression level was assessed using immunohistochemistry,real-time PCR,and Western blotting.After transfecting fibroblasts with silenced PLA2G2A,changes in collagen Ⅰ and collagen Ⅲ were measured.Results The histological structure of the vaginal wall in the POP group was significantly different from that in the control group.PLA2G2A was expressed in fibroblasts,with protein and mRNA expression levels higher than those in the control group(P＜0.05).After silencing PLA2G2A,collagen Ⅰ and collagen Ⅲ expression were upregulated.Conclusion High expression of PLA2G2A in vaginal wall tissue of patients with POP.Increased PLA2G2A expression may be closely related to the development and presence of POP.

Objective:To investigate the association between homocysteine (Hcy) and recurrent pregnancy loss (RPL), as well as its impact on clinical pregnancy outcomes in patients undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). Methods:This retrospective cohort study collected clinical data from patients undergoing IVF/ICSI-ET at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between December 2020 and March 2024. Patients were divided into no history of pregnancy loss group (named control group, n=1 027) and RPL group ( n=743) based on history of pregnancy loss. Peripheral blood Hcy levels were compared between the two groups. Multivariate logistic regression was performed to adjust for confounding factors and determine whether Hcy is an independent risk factor for RPL. RPL patients were divided into four subgroups based on Hcy quartiles, named Q1 subgroup (Hcy<7.03 μmol/L), Q2 subgroup (7.03 μmol/L≤Hcy<8.63 μmol/L), Q3 subgroup (8.63 μmol/L≤Hcy<10.44 μmol/L), and Q4 subgroup (Hcy≥10.44 μmol/L), to further analyze the impact of Hcy level on pregnancy outcomes after IVF/ICSI-ET in these patients. Results:1) Baseline characteristics between control and RPL groups: statistically significant differences were observed in female age, male age, female body mass index (BMI), duration of infertility, cause of infertility, and peripheral blood Hcy levels (all P<0.05). 2) After adjusting for female age, male age, female BMI, duration of infertility, and cause of infertility via multivariate logistic regression, elevated Hcy levels was identified as an independent risk factor for RPL (a OR=1.366, 95% CI: 1.298-1.438, P<0.001). 3) Baseline characteristics of the four RPL subgroups: antral follicle count (AFC) differed significantly among Q1, Q2, Q3 and Q4 subgroups [17.00 (11.00, 24.00), 15.00 (10.00, 24.00), 14.00 (7.00, 22.25), 15.50 (8.00, 22.00), P=0.043]. No statistically significant differences were observed in other baseline characteristics (all P>0.05). 4) Pregnancy outcomes across the four RPL subgroups: miscarriage rates in the Q1, Q2, Q3 and Q4 subgroups were 18.18% (18/99), 30.61% (30/98), 33.70% (31/92), and 35.96% (32/89), respectively, live birth rates were 44.26% (81/183), 36.17% (68/188), 32.80% (61/186), and 30.65% (57/186), respectively. Intergroup differences in miscarriage rate and live birth rate were statistically significant ( P=0.033, P=0.036). Specifically, miscarriage rate in the Q3 and Q4 subgroups, and live birth rate in the Q4 subgroup were significantly higher than those in the Q1 subgroup (all q<0.05). However, no significant differences were observed in clinical pregnancy rate or early miscarriage rate among the four groups (all P>0.05). After adjusting for confounding factors using multivariate logistic regression, taking the Q1 subgroup as the control, there were no statistically significant differences in the clinical pregnancy rate between the remaining groups and the Q1 subgroup (all P>0.05). The early miscarriage rate in the Q3 subgroup (a OR=2.184, 95% CI: 1.077-4.426, P=0.030) and the early miscarriage rate in the Q4 subgroup (a OR=2.290, 95% CI: 1.116-4.697, P=0.024) were significantly higher than those in the Q1 subgroup; the miscarriage rate in the Q3 subgroup (a OR=2.207, 95% CI: 1.125-4.330, P=0.021) and the miscarriage rate in the Q4 subgroup (a OR=2.377, 95% CI: 1.209-4.674, P=0.012) were significantly higher than those in the Q1 subgroup; the live birth rate in the Q3 subgroup (a OR=0.615, 95% CI: 0.401-0.944, P=0.026) and the live birth rate in the Q4 subgroup (a OR=0.560, 95% CI: 0.364-0.863, P=0.009) were significantly lower than those in the Q1 subgroup. Conclusion:Elevated Hcy is a high-risk factor for RPL in IVF/ICSI-ET patients and may adversely affect pregnancy outcomes.

Objective:To evaluate the role of stimulator of interferon genes (STING) in postoperative cognitive dysfunction (POCD) and the relationship with pyroptosis in hippocampal cells in aged mice.Methods:Forty-eight SPF healthy male C57BL/6 mice, aged 18 months, weighing 23-28 g, were assigned to 4 groups ( n=12 each) using a random number table method: control group (C group), POCD group (P group), STING inhibitor C-176 group (PC group), and C-176 solvent group (PV group). The mice underwent Morris water maze training for 4 days prior to model establishment. Mice in P, PC and PV groups underwent tibial fracture and intramedullary pin fixation under sevoflurane anesthesia to establish the POCD model, while mice in C group received no treatment. The STING inhibitor C-176 (750 nmol/200 μl) and an equal volume of C-176 solvent were intraperitoneally injected at 30 min before establishment of the model in PC and PV groups, respectively. The open field test was performed on the 5th day after model preparation, the novel object recognition test was conducted on the 6th day, and the Morris water maze test was performed on the 7th day. Mice were sacrificed under anesthesia to collect the hippocampus for determination of the expression of STING, phosphorylated STING (p-STING), nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), cleaved caspase-1, and gasdermin-D (GSDMD)-NT by Western blot. Results:There were no statistically significant differences in the parameters of the training phase of the Morris water maze test and the open field test among the four groups ( P>0.05). Compared with C group, the recognition index in the novel object recognition test was significantly decreased, the number of crossing the original platform was reduced and the duration spent in the target quadrant was shortened in the Morris water maze test, and the expression of STING, NLRP3, cleaved caspase-1, and GSDMD-NT in hippocampal neurons was up-regulated in P, PC and PV groups, and the expression of p-STING was significantly up-regulated in P and PV groups ( P<0.05). Compared with P group, the recognition index in the novel object recognition test was significantly increased, the number of crossing the original platform was reduced and the duration spent in the target quadrant was prolonged in the Morris water maze test, and the expression of p-STING, NLRP3, cleaved caspase-1, and GSDMD-NT in hippocampal neurons was down-regulated in PC group ( P<0.05). Compared with PC group, the recognition index in the novel object recognition test was significantly decreased, the number of crossing the original platform was reduced and the duration spent in the target quadrant was shortened in the Morris water maze test, and the expression of p-STING, NLRP3, cleaved caspase-1 and GSDMD-NT was up-regulated in PV group ( P<0.05). Conclusions:STING is involved in the development of POCD in aged mice, and the mechanism may be related to promotion of pyroptosis in hippocampal cells.

Objective:To analyze the changing trends and international differences in the incidence and disability-adjusted life years (DALY) of hypertensive disorders in pregnancy (HDP) in China from 1990 to 2021 based on the Global Burden of Disease (GBD) database.Methods:The data were derived from the GBD database, covering the incidence and DALY data of HDP in countries or regions around the world. Descriptive statistics were used to compare the differences in disease burden between China and different regions of Europe, America and other developed countries, and to analyze the disease burden characteristics of women of childbearing age in different age groups (every 5 years). The Joinpoint regression model was used to identify trend change points. The age-period-cohort model was used to analyze the independent effects of age, period and birth cohort.Results:(1) From 1990 to 2021, the incidence of HDP in China showed an overall downward trend, from 387.18/100 000 in 1990 to 216.35/100 000 in 2021. Compared with the global incidence rate (1990: 1 167.28/100 000; 2021: 923.48/100 000), the incidence rate of HDP in China was relatively low, but it was still higher than that in some developed countries. (2) The analysis of the Joinpoint regression model showed that the incidence rate of HDP in different age groups first decreased, then increased, and finally leveled off. The connection point with the lowest point was in 2005. DALY showed a continuous downward trend in all age groups. Among them, the decline in maternal DALY of pregnant women in all age groups from 15 to 39 years old was more obvious. (3) The age-period-cohort effect model showed that the incidence rate and DALY of HDP in women of childbearing age aged 20 to 24 years reached their peak.Conclusions:The burden of HDP in China continues to decrease, and the disease prevention and control has achieved remarkable results, but the incidence rate is still higher than that in some developed countries. It is suggested that personalized interventions should be developed for different risk groups to further reduce the burden of disease.

Objective:To investigate the mode and timing of delivery in pregnant women with complex fetal congenital heart disease (CHD) detected by prenatal ultrasound.Methods:The clinical data of 123 fetuses with complex CHD detected by prenatal ultrasound in Peking University People′s Hospital from January 2016 to December 2023 were retrospectively analyzed. Pregnant women with indications for prenatal diagnosis underwent G-banding karyotype analysis, single nucleotide polymorphism array (SNP arrry) or whole exome sequencing after informed consent. Integrated managements were provided for pregnant women with complex CHD during pregnancy and perinatal period, and to determine the mode and timing of delivery. Infants with complex CHD received timely treatment or referral after birth.Results:The gestational age at ultrasound diagnosis of the 123 fetuses with complex CHD was (23.7±3.4) weeks. There were 11 cases (8.9%) of total anomalous pulmonary venous connection (TAPVC), 14 cases (11.4%) of anomalous pulmonary valve (PVA), 7 cases (5.7%) of right ventricle double outlet (RVDO), 13 cases (10.6%) of anomalous aortic arch, 69 cases (56.1%) of transposition of the great arteries (TGA), 9 cases (7.3%) of other types. All cases were treated with fetal preservation after prenatal consultation. Among the 72 cases undergoing prenatal diagnosis, 9 cases (12.5%) had chromosomal variations. Fifty-five cases (44.7%, 55/123) underwent trial of labor, of which 46 cases (37.4%, 46/123) had successful vaginal delivery, including 6 cases of forceps delivery, and other 9 cases of failed trial of labor transferred to cesarean section. A total of 77 cases of pregnant women underwent cesarean section. Except for the 21 cases of pregnant women who asked for cesarean section, the cesarean section rate of pregnant women with complex CHD was 45.5% (56/123), which was not significantly different from the average cesarean section rate of the same period in our hospital (40.2%; χ2=7.34, P=0.270). The gestational age at delivery of the 123 fetuses with complex CHD was (37.9±1.4) weeks, the birth weight of the neonates was (3 099±480) g, and the umbilical artery blood pH value was 7.31±0.05. The oxygen saturation of 86 cases before and after alprostadil infusion were (72.8±6.0)% and (80.5±5.0)%, respectively, and the difference was statistically significant ( t=4.38, P<0.001). One hundred and fourteen children underwent surgical treatment, 112 of them (98.2%) had good postoperative reexamination. Only 2 cases (1.8%) died after surgery, and 14.0% (16/114) had the possibility of secondary surgery. Conclusions:Fetal complex CHD is not an indication for cesarean section, and the delivery mode could be selected according to the obstetric situation. If the mother and child are in stable condition, the delivery is planned after 39 weeks of gestation. For children with low oxygen saturation after birth, alprostadil could be pumped to maintain the open ductus arteriosus, and timely referral to the pediatric cardiac surgery for subsequent surgical treatment, which could achieve a good prognosis.

Objective:To compare the efficacy of new nasopharyngeal airway and laryngeal mask airway for airway management in the patients undergoing non-intubated video-assisted thoracoscopic surgery (NIVATS).Methods:In this randomised, controlled, non-inferiority trial, 60 American Society of Anesthesiologists Physical Status classification I or Ⅱ patients of both sexes, aged 18-79 yr, scheduled for elective NIVATS from December 2021 to December 2023 at Jining No.1 People′s Hospital, were divided into 2 groups ( n=30 each) using a computer-generated random code in a 1∶1 ratio: new type nasopharyngeal airway group (group N) and laryngeal mask airway group (group L). After anesthesia induction, a new nasopharyngeal airway was inserted in group N, and a laryngeal mask airway was inserted in group L. Spontaneous ventilation was maintained during the NIVATS. Ultrasound-guided serratus anterior plane block was performed on the affected side before anesthesia induction. Anesthesia was maintained with propofol and remifentanil. The primary outcome measure was the rate of intraoperative airway intervention, the airway interventions included repositioning of the airway tools, manual assisted ventilation, jaw-thrust maneuver, and conversion to endotracheal intubation. The secondary outcome measures included the first-attempt success rate of airway device placement, time for establishing a patent airway, the minimum value of SpO 2, the maximum value of P ETCO 2, and incidence of complications such as postoperative sore throat. Results:The rate of intraoperative airway intervention was 27% in group L and 47% in group N ( χ2=2.58, P=0.108). The difference in the rate of intraoperative airway intervention between the two groups was 0.20 (95% confidence interval 0.15-0.25), with a 95% confidence interval upper limit higher than the non-inferiority boundary (10%), indicating that this non-inferiority hypothesis was not established. In comparison to group L, the rate of intraoperative jaw-thrust maneuver intervention was significantly increased, the time to establish a patent airway was shortened, and the incidence of postoperative sore throat was decreased in group N ( P<0.05). Conclusions:Compared with the laryngeal mask airway, the new nasopharyngeal airway can reduce the development of postoperative throat pain, however, it is less effective in maintaining a patent airway. It requires careful consideration of risks and benefits when used for NIVATS.

Intestinal radiosensitivity makes radiation-induced intestinal injury (RIII) as a common complication among individuals exposed to accidental radiation and patients with abdominal or pelvic malignancies receiving radiotherapy. At present, there are no effective measures for the prevention and treatment of RIII. Developing novel prevention and treatment strategies is of great significance for improving the prognosis and quality of life for both individuals exposed to accidental radiation and cancer patients. Lactobacillus, a Gram-positive bacterium, is widely observed in humans and animals. It exhibits notable probiotic functions, including maintaining gut microbiota homeostasis, preserving intestinal barrier, and modulating immune responses. Substantial studies have demonstrated that Lactobacillus has remarkable protective and therapeutic effects against radiation-induced injury, specifically significantly alleviating RIII. These probiotic functions of Lactobacillus make it have high priority to become the chassis of genetically engineered strains. However, multiple factors influence the construction of a genetically engineered strain, limiting the application of Lactobacillus as a chassis. This review focuses on the probiotic functions of Lactobacillus, highlighting advances in research on Lactobacillus and its engineered probiotics in radiation protection and treatment. Furthermore, it summarizes key factors influencing the construction of genetically engineered strains based on the Lactobacillus chassis. It aims to provide insights for developing genetically engineered strains with radioprotective and therapeutic effects using Lactobacillus as the chassis.