Objective:To analyze the relationship between microRNA-21(miR-21)expression and the risk of very early relapse post-induction chemotherapy in children with acute lymphoblastic leukemia(ALL).Methods:A total of 110 newly diagnosed children with ALL admitted to Huanggang Central Hospital from March 2020 to September 2022 were included.All patients received induction chemotherapy according to the CCLG-2008 protocol.The patients who achieved complete response(CR)after induction chemotherapy were followed up for 18 months,with very early relapse as the endpoint event.Then the patients were divided into a relapse group and a non-relapse group.Cox regression was used to analyze the influencing factors of very early relapse after induction chemotherapy in children with ALL.ROC curve and decision curve were used to evaluate the predictive value of peripheral blood miR-21 for very early relapse after induction chemotherapy in children with ALL.Restricted cubic splines were used to analyze the dose-response relationship between peripheral blood miR-21 and very early relapse after induction chemotherapy in children with ALL.Results:A total of 102 children with ALL achieved CR after induction chemotherapy,among whom 24 cases(23.53％)experienced very early relapse,with a median relapse time of 14 months.The proportions of patients with high-risk stratification at initial diagnosis,extramedullary infiltration,and minimal residual disease(MRD)positivity were significantly higher in the relapse group than those in the non-relapse group;The absolute lymphocyte count(ALC)in peripheral blood was significantly lower,while the expression levels of miR-21 and lactate dehydrogenase(LDH)were significantly higher in the relapse group compared with the non-relapse group(all P＜0.05).Cox regression analysis showed that very early relapse after induction chemotherapy in children with ALL was associated with medium risk and high risk at initial diagnosis,extramedullary infiltration,decreased ALC in peripheral blood,MRD positivity,as well as high expression levels of miR-21 and LDH(all P＜0.05).ROC curve analysis indicated that the area under the curve(AUC)of peripheral blood miR-21 for predicting very early relapse after induction chemotherapy in children with ALL was 0.800,with an optimal cutoff value of 4.830.Restricted cubic spline analysis revealed that there was a non-linear dose-response relationship between peripheral blood miR-21 and the risk of very early relapse after induction chemotherapy in children with ALL.When the expression level of peripheral blood miR-21 exceeded 4.830,the risk of very early relapse increased with the elevation of miR-21 expression.Decision curve analysis demonstrated that combining peripheral blood miR-21 with other risk factors enhanced the predictive performance for the risk of very early relapse after induction chemotherapy in children with ALL.Conclusion:Very early relapse after induction chemotherapy in children with ALL is associated with elevated expression of miR-21 in peripheral blood,and high expression of miR-21 may increase the risk of very early relapse.Detecting miR-21 before induction chemotherapy has predictive significance for very early relapse in children with ALL,and combining it with other risk factors can improve the predictive efficacy.

Diabetic foot ulcer (DFU) have emerged as a serious global health issue due to its high rates of occurrence, disability, and mortality. DFU exhibit an exceptionally high recurrence rate, driven by a combination of behavioral and biological factors, leading to the recognition of fully epithelialized ulcers as being in "remission" rather than cured. However, the pathogenic factors underlying recurrent DFU (RDFU) remain poorly understood. This review examines the epidemiological characteristics and pathophysiological mechanisms of RDFU. Key mechanisms include neuropathy, angiopathy, epigenetic modifications, and metabolic memory. Research demonstrates that RDFU development results from the interplay of multiple factors: hyperglycemia-induced metabolic abnormalities, chronic inflammatory responses, vascular and neurological damage, as well as dysregulated epigenetic control. These factors interact synergistically, creating a vicious cycle that increases the risk of recurrence and delays recovery. By synthesizing current knowledge, this review aims to provide a foundation for future research and clinical management of RDFU. The insights presented support the development of personalized treatment strategies and effective preventive measures to reduce recurrence and improve patient outcomes.

Objective To investigate the differences in demographic characteristics,reproductive health status,and the distribution of pregnancy-related diseases between couples conceived via assisted reproductive technology(ART)and naturally conceived couples,and to analyze the impact of ART treatment on the incidence of preterm birth(PTB)in singleton and twin and multiple pregnancies.Methods We conducted a retrospective analysis of the maternal and infant cohort data of Jing'an District from 2013 to 2020.Based on the conception method,the subjects were categorized into two groups:the ART group and the natural conception group.Chi-square test was applied to compare baseline characteristics and disease distributions differences between the two groups,and logistic regression models were used to evaluate the association between ART and the PTB risks.A causal mediation model was used to evaluate the mediating effect of twin and multiple pregnancy in the relationship between ART and PTB.Results A total of 117 717 parturients were included,6 265 in the ART group and 111 452 in the natural conception group.Compared with the natural conception group,couples in the ART group were significantly older and had a higher prevalence of reproductive system diseases.The incidences of diabetes and hypertensive disorders during pregnancy in ART parturient were 13.76%and 9.99%,respectively,which were significantly higher than 7.88%and 4.75%in the natural conception group(both P<0.001).The overall PTB rate in the ART group was 14.81%,higher than 5.35%in the natural conceptions group(P<0.001).The PTB rate in ART for singleton pregnancies in the ART group was 6.40%,higher than 4.83%in the natural conception group(P<0.001),while the PTB rate in ART for twin and multiple pregnancies in the ART group was 53.97%,lower than 60.42%in the natural conception group(P<0.05).Mediation analysis showed that 97.99%of the effect of ART on PTB was mediated by twin and multiple pregnancy,with ART increasing the PTB risk by 3.44 times through multiple pregnancy.Conclusion The overall PTB rate of ART recipients is higher than that of natural recipients,but ART does not increase the PTB risk in singleton and twin and multiple pregnancies.Twin and multiple pregnancy is the key mediating factor contributing to PTB in ART-conceived recipients.Compared with naturally conceived couples,ART conception couples own more advanced maternal age,and have higher risks of suffering gestational diabetes,gestational hypertension,and PTB.

Objective:To analyze the relationship between microRNA-21(miR-21)expression and the risk of very early relapse post-induction chemotherapy in children with acute lymphoblastic leukemia(ALL).Methods:A total of 110 newly diagnosed children with ALL admitted to Huanggang Central Hospital from March 2020 to September 2022 were included.All patients received induction chemotherapy according to the CCLG-2008 protocol.The patients who achieved complete response(CR)after induction chemotherapy were followed up for 18 months,with very early relapse as the endpoint event.Then the patients were divided into a relapse group and a non-relapse group.Cox regression was used to analyze the influencing factors of very early relapse after induction chemotherapy in children with ALL.ROC curve and decision curve were used to evaluate the predictive value of peripheral blood miR-21 for very early relapse after induction chemotherapy in children with ALL.Restricted cubic splines were used to analyze the dose-response relationship between peripheral blood miR-21 and very early relapse after induction chemotherapy in children with ALL.Results:A total of 102 children with ALL achieved CR after induction chemotherapy,among whom 24 cases(23.53％)experienced very early relapse,with a median relapse time of 14 months.The proportions of patients with high-risk stratification at initial diagnosis,extramedullary infiltration,and minimal residual disease(MRD)positivity were significantly higher in the relapse group than those in the non-relapse group;The absolute lymphocyte count(ALC)in peripheral blood was significantly lower,while the expression levels of miR-21 and lactate dehydrogenase(LDH)were significantly higher in the relapse group compared with the non-relapse group(all P＜0.05).Cox regression analysis showed that very early relapse after induction chemotherapy in children with ALL was associated with medium risk and high risk at initial diagnosis,extramedullary infiltration,decreased ALC in peripheral blood,MRD positivity,as well as high expression levels of miR-21 and LDH(all P＜0.05).ROC curve analysis indicated that the area under the curve(AUC)of peripheral blood miR-21 for predicting very early relapse after induction chemotherapy in children with ALL was 0.800,with an optimal cutoff value of 4.830.Restricted cubic spline analysis revealed that there was a non-linear dose-response relationship between peripheral blood miR-21 and the risk of very early relapse after induction chemotherapy in children with ALL.When the expression level of peripheral blood miR-21 exceeded 4.830,the risk of very early relapse increased with the elevation of miR-21 expression.Decision curve analysis demonstrated that combining peripheral blood miR-21 with other risk factors enhanced the predictive performance for the risk of very early relapse after induction chemotherapy in children with ALL.Conclusion:Very early relapse after induction chemotherapy in children with ALL is associated with elevated expression of miR-21 in peripheral blood,and high expression of miR-21 may increase the risk of very early relapse.Detecting miR-21 before induction chemotherapy has predictive significance for very early relapse in children with ALL,and combining it with other risk factors can improve the predictive efficacy.

Objective To investigate the differences in demographic characteristics,reproductive health status,and the distribution of pregnancy-related diseases between couples conceived via assisted reproductive technology(ART)and naturally conceived couples,and to analyze the impact of ART treatment on the incidence of preterm birth(PTB)in singleton and twin and multiple pregnancies.Methods We conducted a retrospective analysis of the maternal and infant cohort data of Jing'an District from 2013 to 2020.Based on the conception method,the subjects were categorized into two groups:the ART group and the natural conception group.Chi-square test was applied to compare baseline characteristics and disease distributions differences between the two groups,and logistic regression models were used to evaluate the association between ART and the PTB risks.A causal mediation model was used to evaluate the mediating effect of twin and multiple pregnancy in the relationship between ART and PTB.Results A total of 117 717 parturients were included,6 265 in the ART group and 111 452 in the natural conception group.Compared with the natural conception group,couples in the ART group were significantly older and had a higher prevalence of reproductive system diseases.The incidences of diabetes and hypertensive disorders during pregnancy in ART parturient were 13.76%and 9.99%,respectively,which were significantly higher than 7.88%and 4.75%in the natural conception group(both P<0.001).The overall PTB rate in the ART group was 14.81%,higher than 5.35%in the natural conceptions group(P<0.001).The PTB rate in ART for singleton pregnancies in the ART group was 6.40%,higher than 4.83%in the natural conception group(P<0.001),while the PTB rate in ART for twin and multiple pregnancies in the ART group was 53.97%,lower than 60.42%in the natural conception group(P<0.05).Mediation analysis showed that 97.99%of the effect of ART on PTB was mediated by twin and multiple pregnancy,with ART increasing the PTB risk by 3.44 times through multiple pregnancy.Conclusion The overall PTB rate of ART recipients is higher than that of natural recipients,but ART does not increase the PTB risk in singleton and twin and multiple pregnancies.Twin and multiple pregnancy is the key mediating factor contributing to PTB in ART-conceived recipients.Compared with naturally conceived couples,ART conception couples own more advanced maternal age,and have higher risks of suffering gestational diabetes,gestational hypertension,and PTB.

With the rapid development of generative artificial intelligence(GAI)technologies,their widespread application in academic research and writing is continuously expanding the boundaries of sci-entific inquiry.However,this trend has also raised a series of ethical and regulatory challenges,inclu-ding issues related to authorship,content authenticity,citation accuracy,and accountability.In light of the growing involvement of AI in generating academic content,establishing an open,controllable,and trustworthy ethical governance framework has become a key task for safeguarding research integrity and maintaining trust within the academic community.This expert consensus outlines ethical requirements across key stages of AI-assisted academic writing-including topic selection,data management,citation practices,and authorship attribution.It aims to clarify the boundaries and ethical obligations surrounding AI use in academic writing,ensuring that technological tools enhance efficiency without compromising in-tegrity.The goal is to provide guidance and institutional support for building a responsible and sustainable research ecosystem.

Objective To investigate the effects of sauchinone(Sch)on the growth and immune escape of liver cancer cells by regulating the Krüppel like factor 5(KLF5)-erythropoietin-producing hepatocellular receptor A2(EphA2)pathway.Methods Huh-7 cells were grouped into liver cancer group,Sch low,medium,and high-dose groups(Sch-L group,Sch-M group,Sch-H group),Sch-H+KLF5 activator negative control group(OE-NC),and Sch-H+KLF5 activator(OE-KLF5)group.5-bromo-2-deoxyuracil(EdU)staining,CCK-8,scratch assay,and Transwll were used to detect the proliferation,migration,and invasion of Huh-7 cells,respectively.Western blot was applied to detect proliferative cell nuclear antigen(PCNA),migration invasion enhancer(MIEN1),matrix metalloproteinase-2(MMP-2),programmed death receptor ligand 1(PD-L1),KLF5,and EphA2 proteins in Huh-7 cells.The Huh-7 cells in above 6 groups were co cultured with activated CD8+T cells in a 96 well plate and named as liver cancer co culture group,Sch-L co culture group,Sch-M co culture group,Sch-H co culture group,Sch-H+OE-NC co culture group,and Sch-H+OE-KLF5 co culture group.The killing rate of CD8+T cells in the co culture system and the levels of interferon-γ(IFN-γ),interleukin-4(IL-4),and tumor necrosis factor-α(TNF-α)in the supernatant were detected.Results Compared with the liver cancer group,the EdU positive rate,OD450 value,cell invasion number,and PCNA,MIEN1,MMP-2,PD-L1,KLF5,and EphA2 proteins in the Sch-L,Sch-M,and Sch-H groups reduced,the migration distance shorten(P<0.05).Compared with the Sch-H group and Sch-H+OE-NC group,the EdU positive rate,OD450 value,cell invasion number,and PCNA,MIEN1,MMP-2,PD-L1,KLF5,and EphA2 proteins in the Sch-H+OE-KLF5 group increased,the migration distance prolonged(P<0.05).Compared with the liver cancer co culture group,the killing rate of CD8+T cells on Huh-7 cells and the levels of IFN-γ,TNF-α,and IL-4 in the supernatant in the Sch-L co culture group,Sch-M co culture group,and Sch-H co culture group increased(P<0.05).Compared with the Sch-H co culture group and the Sch-H+OE-NC co culture group,the killing rate of CD8+T cells on Huh-7 cells and the levels of IFN-γ,TNF-α,and IL-4 in the supernatant in the Sch-H+OE-KLF5 co culture group decreased(P<0.05).Conclusion Sch may inhibit growth and immune escape of liver cancer cells by inhibiting the KLF5-EphA2 pathway.

Background: In acute and chronic renal inflammatory diseases, the activation of inflammatory cells is involved in the defect of erythropoietin (EPO) production. Ras guanine nucleotide-releasing protein-4 (RasGRP4) promotes renal inflammatory injury in type 2 diabetes mellitus (T2DM). Our study aimed to investigate the role and mechanism of RasGRP4 in the production of renal EPO in diabetes. Methods: The degree of tissue injury was observed by pathological staining. Inflammatory cell infiltration was analyzed by immunohistochemical staining. Serum EPO levels were detected by enzyme-linked immunosorbent assay, and EPO production and renal interstitial fibrosis were analyzed by immunofluorescence. Quantitative real-time polymerase chain reaction and Western blotting were used to detect the expression of key inflammatory factors and the activation of signaling pathways. In vitro, the interaction between peripheral blood mononuclear cells (PBMCs) and C3H10T1/2 cells was investigated via cell coculture experiments. Results: RasGRP4 decreased the expression of hypoxia-inducible factor 2-alpha (HIF2A) via the ubiquitination–proteasome degradation pathway and promoted myofibroblastic transformation by activating critical inflammatory pathways, consequently reducing the production of EPO in T2DM mice. Conclusion RasGRP4 participates in the production of renal EPO in diabetic mice by affecting the secretion of proinflammatory cytokines in PBMCs, degrading HIF2A, and promoting the myofibroblastic transformation of C3H10T1/2 cells.

Background: In acute and chronic renal inflammatory diseases, the activation of inflammatory cells is involved in the defect of erythropoietin (EPO) production. Ras guanine nucleotide-releasing protein-4 (RasGRP4) promotes renal inflammatory injury in type 2 diabetes mellitus (T2DM). Our study aimed to investigate the role and mechanism of RasGRP4 in the production of renal EPO in diabetes. Methods: The degree of tissue injury was observed by pathological staining. Inflammatory cell infiltration was analyzed by immunohistochemical staining. Serum EPO levels were detected by enzyme-linked immunosorbent assay, and EPO production and renal interstitial fibrosis were analyzed by immunofluorescence. Quantitative real-time polymerase chain reaction and Western blotting were used to detect the expression of key inflammatory factors and the activation of signaling pathways. In vitro, the interaction between peripheral blood mononuclear cells (PBMCs) and C3H10T1/2 cells was investigated via cell coculture experiments. Results: RasGRP4 decreased the expression of hypoxia-inducible factor 2-alpha (HIF2A) via the ubiquitination–proteasome degradation pathway and promoted myofibroblastic transformation by activating critical inflammatory pathways, consequently reducing the production of EPO in T2DM mice. Conclusion RasGRP4 participates in the production of renal EPO in diabetic mice by affecting the secretion of proinflammatory cytokines in PBMCs, degrading HIF2A, and promoting the myofibroblastic transformation of C3H10T1/2 cells.

Background: In acute and chronic renal inflammatory diseases, the activation of inflammatory cells is involved in the defect of erythropoietin (EPO) production. Ras guanine nucleotide-releasing protein-4 (RasGRP4) promotes renal inflammatory injury in type 2 diabetes mellitus (T2DM). Our study aimed to investigate the role and mechanism of RasGRP4 in the production of renal EPO in diabetes. Methods: The degree of tissue injury was observed by pathological staining. Inflammatory cell infiltration was analyzed by immunohistochemical staining. Serum EPO levels were detected by enzyme-linked immunosorbent assay, and EPO production and renal interstitial fibrosis were analyzed by immunofluorescence. Quantitative real-time polymerase chain reaction and Western blotting were used to detect the expression of key inflammatory factors and the activation of signaling pathways. In vitro, the interaction between peripheral blood mononuclear cells (PBMCs) and C3H10T1/2 cells was investigated via cell coculture experiments. Results: RasGRP4 decreased the expression of hypoxia-inducible factor 2-alpha (HIF2A) via the ubiquitination–proteasome degradation pathway and promoted myofibroblastic transformation by activating critical inflammatory pathways, consequently reducing the production of EPO in T2DM mice. Conclusion RasGRP4 participates in the production of renal EPO in diabetic mice by affecting the secretion of proinflammatory cytokines in PBMCs, degrading HIF2A, and promoting the myofibroblastic transformation of C3H10T1/2 cells.