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.

Objective To analyze the status of 2 649 suspected pertussis patients in Xi'an and the changes in laboratory diagnostic indi-cators.Methods 2 649 patients with suspected pertussis who visited the Second Affiliated Hospital of Xi'an Jiaotong University from June 2023 to May 2025 were collected as the research subjects.Nasopharyngeal swabs were collected from the patients,and pertussis nucleic acid was detected by polymerase chain reaction(PCR)-fluorescence probe method.Laboratory diagnostic indicators were an-alyzed.Results Among the 2 649 samples tested,250 were positive for pertussis nucleic acid,with a positive detection rate of 9.44%.The detection rate in male patients was 9.37%(127/1 356),and in female patients was 9.51%(123/1 293),with difference no was statis-tically significant between the two groups(χ2=0.019,P=0.894).There was a statistically significant difference in the positive detection rate among different age groups(χ2=46.473,P<0.05),with the highest positive detection rate in the 7～19 age group(14.98%).The prevalence of pertussis showed a seasonal characteristic with a peak from April to September.21.2%(53/250)of the positive patients were mixed infections.In the 1～14 age group,the white blood cell count(WBC),lymphocyte percentage(LYMP%),and lymphocyte count(LYMP#)in the pertussis infection group were higher than those in the Mycoplasma pneumoniae(MP)infection group(t=10.179,5.819,8.614)and the Respiratory syncytial virus(RSV)infection group(t=16.570,2.618,7.185),and the differences were statistically significant(all P<0.01),respectively.In the＞14 age group,the LYMP%and LYMP#in the pertussis infection group were higher than those in the MP infection group(t=3.275,2.319)and the RSV infection group(t=2.401,4.617),and the differences were statistically significant(all P<0.05),respectively.Conclusion The pertussis infection status in Xi'an area from 2023 to 2025 shows significant char-acteristics in terms of age,season and laboratory test results.It is necessary to further improve the pertussis surveillance system in this area,optimize the clinical diagnosis and treatment process and strengthen the vaccination work of pertussis vaccine.

Objective:To investigate the effect of the transfer of blastocysts that have not re-expanded after 2-4 h of thawing on pregnancy and neonatal outcomes.Methods:A retrospective cohort study was performed to analyze the clinical data from 2 428 vitrified frozen-thawed single blastocyst transfer cycles at the Reproductive Medicine Center of the 901st Hospital of the Joint Logistics Support Force of PLA between January 2015 and March 2024. Based on the re-expansion status of the blastocoel cavity after thawing, the cycles were divided into group A (110 non-re-expanded) and group B (2 318 re-expanded). After propensity score matching, there were 109 cycles in each group. Pregnancy and neonatal outcomes between the two groups were compared.Results:Before propensity score matching, there were statistical differences in percentage of good-quality blastocyst transfer, percentage of degree 4 blastocyst, percentage of endometriosis and others in reasons for infertility between the two groups (all P<0.05). After propensity score matching, there were no statistical differences in baseline characteristics between the two groups (all P>0.05). The clinical pregnancy rate [27.52% (30/109)], the ongoing pregnancy rate [21.10% (23/109)] and the live birth rate [19.27% (21/109)] in group A were all significantly lower than those in group B [61.47% (67/109), 51.38% (56/109), 47.70% (52/109), all P<0.001]. Neonatal outcomes showed no statistically significant differences between the two groups in terms of birth weight, neonatal length, malformation rate, monozygotic twin rate and male neonatal rate (all P>0.05). Conclusion:Transfer of non-re-expanded blastocysts after thawing may reduce clinical pregnancy rate but does not negatively affect neonatal outcomes.

The scientific research and innovation capabilities of medical students are intrinsically linked to the sustained and high-quality development of national healthcare initiatives.Cultivating outstanding medi-cal students with independent scientific capabilities and innovative consciousness is a critical component in the education and training of high-level medical professionals.Our investigation revealed that within the imperfections of the cultivating model,some faculty and students at medical schools have an insufficient understanding of scientific research and innovation and lack motivation for engaging in such activities,which hinder the progression of scientific research activities.Consequently,we initiated a teaching practice and exploratory study on the"tutorial system"aimed at fostering medical students'scientific research and innovation abilities.Based on the principle of"research informing teaching,teaching and research advan-cing together,"this study implements a"tutorial system"coordinated by tutors,supplemented by graduate and undergraduate student mentors,to cultivate innovative thinking,stimulate interest in scientific re-search,and enhance practical and research skills among medical students.Through collaborative efforts within"scientific research innovation teams,"various educational methods—including preliminary re-search,in-class and extracurricular activities,intra-group and inter-group interactions,and theoretical and practical applications—are employed to improve and strengthen the cultivation of medical students'scientif-ic research and innovation abilities.This study aims to provide valuable references for optimizing medical education management systems and enhancing the quality of medical student training.

The scientific research and innovation capabilities of medical students are intrinsically linked to the sustained and high-quality development of national healthcare initiatives.Cultivating outstanding medi-cal students with independent scientific capabilities and innovative consciousness is a critical component in the education and training of high-level medical professionals.Our investigation revealed that within the imperfections of the cultivating model,some faculty and students at medical schools have an insufficient understanding of scientific research and innovation and lack motivation for engaging in such activities,which hinder the progression of scientific research activities.Consequently,we initiated a teaching practice and exploratory study on the"tutorial system"aimed at fostering medical students'scientific research and innovation abilities.Based on the principle of"research informing teaching,teaching and research advan-cing together,"this study implements a"tutorial system"coordinated by tutors,supplemented by graduate and undergraduate student mentors,to cultivate innovative thinking,stimulate interest in scientific re-search,and enhance practical and research skills among medical students.Through collaborative efforts within"scientific research innovation teams,"various educational methods—including preliminary re-search,in-class and extracurricular activities,intra-group and inter-group interactions,and theoretical and practical applications—are employed to improve and strengthen the cultivation of medical students'scientif-ic research and innovation abilities.This study aims to provide valuable references for optimizing medical education management systems and enhancing the quality of medical student training.

Objective To investigate the clinical features of patients with China Liver Cancer Staging(CNLC)stage Ⅲhepatocellular carcinoma(HCC)achieving five-year sustained complete remission(CR)after local treatment combined with systemic therapy,as well as potential contributing factors,and to provide a reference for optimizing the treatment of advanced HCC.Methods A retrospective analysis was performed for the clinical data of six patients with CNLC stage Ⅲ HCC who were treated in Department of Interventional Radiology,The First Affiliated Hospital of Soochow University,from January 2016 to December 2019 and achieved five-year sustained CR.Baseline characteristics,treatment modalities,and follow-up data were summarized,and a literature review was performed.Results The six patients had a mean age of 58.3±10.1 years,among whom five had stage Ⅲa HCC and one had stage Ⅲb HCC,and all patients had a history of hepatitis.The mean preoperative MELD score was 8.2±0.8 for the six patients,and there were five patients with Child-Pugh class A liver function and one with Child-Pugh class B liver function.All patients underwent transcatheter arterial chemoembolization,followed by sequential targeted drug therapy after surgery,with sorafenib for four patients and lenvatinib for two patients.Four patients with main portal vein tumor thrombus also received 125I seed implantation,one patient with the single-nodule type underwent radiofrequency ablation,and three patients received immunotherapy with camrelizumab.The median time to AFP normalization was 6 months,the median time from treatment to CR was 5.5 months,and the median follow-up time was 63 months.Conclusion Good liver function at baseline,an early and rapid reduction in AFP,and the combination of local treatment and systemic therapy are key factors for achieving long-term CR in patients with advanced HCC.Multi-center large-scale studies are needed in the future to further explore prognostic factors and optimize treatment regimens.

Aim To explore the effects of D-limonene on the steatosis of primary mouse hepatocytes and its potential mechanism of action.Methods Oleic acid-induced steatosis in primary mouse hepatocytes was used as a model to observe the effects of D-limonene on cell viability,cellular lipid content,and intracellular expression of proteins such as AMP-activated protein kinase(AMPK),acetyl-coenzyme A carboxylase 1(ACC1),and carnitine palmitoyl transferase 1A(CPT1A).Results It was found that a low dose of D-limonene could effectively enhance the viability of primary mouse hepatocytes.When oleic acid at a con-centration of 300 μmol·L-1 successfully induced steatosis in primary mouse hepatocytes,D-limonene re-duced the lipid content of the cells,and D-limonene up-regulated the cellular AMPK expression level,down-regulated the cellular ACC1 and fatty acid synthetase(FAS)expression levels,which in turn promoted the overexpression of CPT1A.Conclusions D-limonene has the effect of reducing lipid deposition in primary mouse hepatocytes,and the mechanisms may be related to the activation of AMPK,the inhibitions of ACC1 and FAS,and the up-regulation of CPT1A protein expres-sion level.

Objective:To investigate the effect of the transfer of blastocysts that have not re-expanded after 2-4 h of thawing on pregnancy and neonatal outcomes.Methods:A retrospective cohort study was performed to analyze the clinical data from 2 428 vitrified frozen-thawed single blastocyst transfer cycles at the Reproductive Medicine Center of the 901st Hospital of the Joint Logistics Support Force of PLA between January 2015 and March 2024. Based on the re-expansion status of the blastocoel cavity after thawing, the cycles were divided into group A (110 non-re-expanded) and group B (2 318 re-expanded). After propensity score matching, there were 109 cycles in each group. Pregnancy and neonatal outcomes between the two groups were compared.Results:Before propensity score matching, there were statistical differences in percentage of good-quality blastocyst transfer, percentage of degree 4 blastocyst, percentage of endometriosis and others in reasons for infertility between the two groups (all P<0.05). After propensity score matching, there were no statistical differences in baseline characteristics between the two groups (all P>0.05). The clinical pregnancy rate [27.52% (30/109)], the ongoing pregnancy rate [21.10% (23/109)] and the live birth rate [19.27% (21/109)] in group A were all significantly lower than those in group B [61.47% (67/109), 51.38% (56/109), 47.70% (52/109), all P<0.001]. Neonatal outcomes showed no statistically significant differences between the two groups in terms of birth weight, neonatal length, malformation rate, monozygotic twin rate and male neonatal rate (all P>0.05). Conclusion:Transfer of non-re-expanded blastocysts after thawing may reduce clinical pregnancy rate but does not negatively affect neonatal outcomes.

Objective:To observe the effects of early enteral nutrition(EN)intervention on neurological function,nutritional status,and inflammatory stress response in patients with severe traumatic brain injury.Methods:This study was a single-center prospective study,68 patients with severe traumatic brain injury were divided into control group[received parenteral nutrition(PN)intervention,n=34]and observation group(received early EN intervention,n=34)according to the envelope lottery method.The improvement of neurological function[serum central nervous system specific(S1 00(3)protein,national institutes of health stroke scale(NIHSS)score,myelin basic protein(MBP)],nutritional status[transferrin(TRF),total protein(TP),albumin(ALB)and prealbumin(PA)],inflammatory stress indicators[C-reactive protein(CRP),procalcitonin(PCT),glutathione peroxidase(GSH-PX),malondialdehyde(MDA)],daily living activity ability,quality of life,and incidence of complications between two groups were compared.Results:Compared with the control group after intervention,the observation group had lower NIHSS scores,S100[3 protein,MBP,CRP,PCT and MDA,had higher TRF,TP,ALB,PA,GSH-PX,improved Barthel index and world health organization quality of life assessment scale-100(WHOQOL-100)score(P＜0.05).There was no difference in the incidence of complications between the two groups(P＞0.05).Conclusion:Early EN intervention in patients with severe traumatic brain injury can effectively improve neurological function,nutritional status,and reduce the body's inflammatory stress response,which is worthy of clinical reference and application.

Objective This study aims to discuss and summarize the management system for drugs used in clinical trials,with the objective of elevating the management standards.Methods Considering the situation of diverse departmental needs and the multi-campus structure,the study analyzed and explored the management of drugs for clinical trials to build a corresponding management system,including pharmacy construction,equipment,personnel qualifications,data management,drug reception,storage,distribution,and recycling protocols.The effecttivness of the system was evaluated through comparative analysis of data from 2022 to 2023 at our hospital.Result Improvements in the management of drugs for clinical trials were observed in 2023 across varous aspects.Conclusion Refining the management system of drugs for clinical trials can enhance Good Clinical Practice(GCP)supervision and service,providing an important reference for the management system.