Objective: To analyze the association between intraoperative blood transfusion and adverse perinatal outcomes(a composite of maternal death, hepatic encephalopathy, etc) in patients with acute fatty liver of pregnancy (AFLP), identify independent risk factors for these outcomes, and develop and validate a risk prediction model for early identification of high-risk patients. Methods: Clinical data of 56 AFLP patients admitted to our hospital from January 2008 to January 2025 were retrospectively analyzed. The chi-square test was used to compare the incidence of adverse perinatal outcomes between the transfusion group and the non-transfusion group. Univariate and multivariate Firth-penalized logistic regression analyses were performed to identify independent predictors of adverse outcomes. Based on the identified independent risk factors, a combined prediction model was developed. Internal validation was performed using the Bootstrap method (1 000 resamplings) to assess the model′s generalizability. Model performance was evaluated using receiver operating characteristic(ROC) curves and calibration curves. Finally, a nomogram for predicting adverse perinatal outcomes in AFLP was constructed. Results: Overall, 57.1%(32/56) of the patients received blood product transfusion during the termination of pregnancy. Multivariate Firth-penalized logistic regression analysis showed that, given the limited sample size, intraoperative blood transfusion had no independent statistical effect on adverse outcomes (OR=0.812, 95%CI:0.133-3.698, P=0.797). Mediation analysis also revealed no significant indirect effect. The independent risk factors were decreased preoperative fibrinogen (OR=14.062, 95%CI:2.389-126.656, P=0.003), pregnancy with infection (OR= 4.536, 95%CI:1.143-22.107, P=0.031), and cesarean section (OR=8.691, 95%CI:1.321-90.081, P=0.023). The combined prediction model achieved an AUC of 0.881 (95% CI:0.793-0.969, P<0.001), indicating good discrimination. At the optimal cut-off value, the sensitivity was 65.6%, specificity 95.8%, positive predictive value 95.5%, and negative predictive value 67.6%. Internal validation by the Bootstrap method showed that the predictive model had good discrimination and no obvious overfitting. The calibration curve demonstrated that the model′s predicted risk was consistent with the actual observed risk. Based on this, an AFLP perinatal adverse outcome nomogram model was constructed. Conclusion: Under the limited sample size of this study, no independent statistical effect of intraoperative blood product infusion on adverse perinatal outcomes in AFLP patients was detected. A multivariate Firth-penalized logistic regression model incorporating decreased preoperative fibrinogen, pregnancy with infection, and cesarean delivery demonstrated good discrimination and calibration. The derived nomogram may serve as an exploratory tool for early risk stratification and proactive intervention.

Background Large-for-gestational-age (LGA) births are associated with adverse perinatal outcomes and increased risks of offspring obesity, metabolic syndrome, and cardiovascular diseases later in life. Beyond traditional risk factors, exposure to environmental factors, especially fine particulate matter (PM_2.5), before and during pregnancy may contribute to excessive fetal growth; however, the roles of specific chemical constituents and critical exposure windows remain unclear. Objective To examine the associations between maternal exposures to PM_2.5 and its chemical constituents before and during pregnancy and the risk of delivering LGA infants. Methods Singleton pregnancies from the National Free Preconception Health Examination Project between 2010 and 2014 were included. Individual exposures to PM_2.5 and its constituents were estimated for preconception and pregnancy windows using geocoded residential addresses. The associations of single and mixed exposures with LGA risk were analyzed using generalized linear models (GLMs) and qg-computation. Results Exposures to PM_2.5 and its major chemical constituents were significantly associated with an increased LGA risk, with differences in effect magnitude across components. Secondary inorganic aerosols showed the strongest associations. For full-pregnancy exposure, nitrate (OR=1.330, 95%CI: 1.313, 1.347), ammonium (OR=1.279, 95%CI: 1.263, 1.295), and sulfate (OR=1.242, 95%CI: 1.227, 1.257) had larger effects on LGA risk than black carbon and organic matter. Analysis by exposure window indicated that the month preceding conception and the third trimester of pregnancy were critical exposure windows for susceptibility, while the strongest effect was observed for full-pregnancy exposure, suggesting a cumulative effect over time. Mixed exposure analysis further showed that nitrate and sulfate consistently accounted for the main positive contributions across different time windows. Conclusion Maternal exposures to PM_2.5 and its chemical components before and during pregnancy are associated with an elevated LGA risk. Nitrate and sulfate show consistent and strong associations across pregnancy stages, underscoring the importance of component composition and exposure timing in fetal overgrowth.

The paper introduces Professor SUN Shentian's experience in clinical practice of Ningshen (tranquilizing the mind) point. This point is an empirical point discovered by Professor SUN on the basis of meridian differentiation, nerve function and anatomic location, and in association with the years of clinical practice. The point is located in the prefrontal area, jointed with the distribution of the governor vessel, and responded to the body surface projection area of the frontal pole. It works on regulating the mind, regaining consciousness, improving cognition, alleviating depression, mutually treating physical and mental disorders, as well as unblocking collaterals, regulating the tendons and relieving spasm. This point is widely used in treatment of mental disorders, stroke and extrapyramidal diseases and obtains the reliable therapeutic effect in clinical practice.
Humans ; Acupuncture Points ; Acupuncture Therapy/history* ; China ; Meridians ; History, 20th Century

Objective To explore the characteristics of the inhibitory effect of Evodiamine on the proliferation of activated T cells. Methods Mononuclear cells from peripheral blood (PBMCs) were obtained from healthy donors through density gradient centrifugation, and T cells were subsequently purified by using immunomagnetic bead separation. T cell activation was induced by employing anti-human CD3 and anti-human CD28 antibodies. T cells were treated with different concentrations of EVO (0.37, 1.11, 3.33, and 10)μmol/L. Flow cytometry was applied to evaluate the proliferation index, apoptosis rate, viability, CD25 expression levels, and cell cycle distribution of T cells. The expression levels of cytokines IL-2, IL-17A, IL-4, and IL-10 were quantified by using ELISA. Results 1.11, 3.33 and 10 μmol/L EVO effectively inhibited the proliferation of activated T cells, with an IC₅₀ of (1.5±0.3)μmol/L. EVO did not induce apoptosis in activated T cells and affect the survival rate of resting T cells. EVO did not affect the expression of CD25 and the secretion of IL-2 in activated T cells. EVO arrested the T cell cycle at the G2/M phase, resulting in an increase in G2/M phase cells, and exhibited a concentration-dependent effect. EVO did not affect the secretion of IL-4, IL-10 by activated T cells, but significantly inhibited the secretion of IL-17A. Conclusion EVO did not significantly affect the activation process of T cells but inhibited T cell proliferation by arresting the cell cycle at the G2/M phase and significantly suppressed the secretion of the pro-inflammatory cytokine IL-17A, which suggests that EVO has the potential to serve as a lead compound for the development of low-toxicity and high-efficiency immunosuppressants and elucidates the mechanisms underlying the anti-inflammatory and immunomodulatory effects of the traditional Chinese medicine Evodia rutaecarpa.
Humans ; Cell Proliferation/drug effects* ; Quinazolines/pharmacology* ; T-Lymphocytes/metabolism* ; Lymphocyte Activation/drug effects* ; Apoptosis/drug effects* ; Interleukin-4/metabolism* ; Interleukin-10/metabolism* ; Interleukin-2 Receptor alpha Subunit/metabolism* ; Interleukin-17/metabolism* ; Interleukin-2/metabolism* ; Cell Cycle/drug effects* ; Cells, Cultured

BACKGROUND:The liver,as the main target organ for arsenic toxicity,has become the focus of studies related to the mechanism of action of arsenic toxicity.OBJECTIVE:To investigate the effects of sodium arsenite(NaAsO2)on lipid metabolism,cell proliferation,apoptosis,and expression of related regulatory factors in human normal hepatocytes.METHODS:MIHA normal human hepatocyte cell lines were exposed to 0,10,20,and 30 μmol/L NaAsO2 for 48 hours.Cell morphology changes were observed by light microscopy.Cell viability was detected by CCK-8 assay.The cell serum total cholesterol,triacylglycerol,and total bile acids were detected by single-agent COD-PAP assay,single-agent GPO-PAP assay,and enzyme microplate assay.The intracellular lipid content was detected by oil red O staining.Cell proliferation was detected by Edu-488 infiltration.Cell cycle and apoptosis were detected by PI staining and Annexin V-FITC/PI dual-labeling combined with flow cytometry.The mRNA and protein expression levels of hepatocyte nuclear factor 4 alpha,cholesterol 7α-hydroxylase,and farnesoid X receptor were detected by real-time fluorescence quantitative PCR and western blot assay,respectively.RESULTS AND CONCLUSION:(1)Compared with the control group(0 μmol/L NaAsO2),with the increase of NaAsO2 concentration:MIHA cell viability decreased gradually.The content of total cholesterol and triacylglycerol in cell supernatant increased gradually,while the contents of total bile acids decreased gradually.The content of intracellular lipid increased gradually.The proportion of cells stagnating in S phase and G2/M phase gradually increased,and the apoptosis rate gradually increased.The expression level of hepatocyte nuclear factor 4 alpha mRNA did not show significant changes,while cholesterol 7α-hydroxylase and farnesoid X receptor mRNA expression levels decreased.The protein expression levels of hepatocyte nuclear factor 4 alpha,cholesterol 7α-hydroxylase,and farnesoid X receptor decreased gradually.(2)NaAsO2 has cytotoxicity,significantly reduces MIHA cell viability,induces cell steatosis,inhibits cell proliferation,and induces cell apoptosis.NaAsO2 down-regulates hepatocyte nuclear factor 4 alpha protein expression and the transcription and expression of cholesterol 7α-hydroxylase and farnesoid X receptor,which further induces lipid metabolism disorders in hepatocytes.

Cognitive impairment is one of the most common non-motor symptoms of Parkinson′s disease, which seriously affects the health and quality of life of patients. Therefore, it is particularly important to identify and predict the future cognitive decline of this population. Cognitive reserve can compensate for brain damage caused by aging and brain diseases, and reduce and delay cognitive decline, reflecting the different sensitivity of individuals to cognitive impairment. However, the specific relationship between the two is not fully understood. This paper mainly analyzes the concept, measurement method, genetics and functional imaging of cognitive reserve in Parkinson′s disease to further reveal the relationship between cognitive impairment and cognitive reserve in Parkinson′s disease.

The elimination of biofilms is a crucial step in controlling hospital-acquired infections.Once biofilms colonize luminal instruments,it is difficult to remove them using traditional disinfection methods.Conventional disinfection approaches now face a series of challenges,including microbial resistance,corrosiveness,cytotoxicity,residual disinfection byproducts,and environmental pollution.Therefore,developing novel disinfection technologies specifically targeting biofilm removal is vitally important.New disinfection technologies,such as slightly acidic electrolyzed water,plasma technology,surface modification techniques,nanomaterial-based disinfection,bacteriophage disinfection,and enzymatic disinfection,are constantly emerging.These technologies exhibit excellent performance against biofilms by leveraging the synergistic effects of multiple mechanisms,including the reactive oxygen species(ROS)burst,photocatalytic oxidation,physical disruption,and biological targeting.This review summarizes the characteristics,underlying mechanisms,and potential application scenarios of these novel disinfection technologies,with a particular focus on their effects against biofilms formed by common pathogenic bacteria on surfaces in hospital settings.It aims to provide a reference basis for the practical application and translation of these disinfection technologies and the development of new disinfection strategies.

This article focuses on the clinical need for curative interventions in chronic diseases.It proposes an inte-grated medical framework that combines"quantum prediction,prevention and control through Traditional Chinese and Western Medicine,and stem cell repair"and details its path to clinical application.To address the complex,multi-target pathology of diseases like diabetes,this research integrates multiple disciplines:stem cell technology,the holistic philosophy of Traditional Chinese Medicine(TCM),the evidence-based rigor of Western Medicine,and the cutting-edge concepts of quantum biology.The goal is to create a new diagnostic and therapeutic model that syn-thesizes disease and syndrome classification while bridging macro and micro perspectives,ultimately driving break-throughs in chronic disease management.Theoretically,the study proposes a strategy to rejuvenate cells and remodel the microenvironment using pluripotent stem cells combined with synergistic TCM-Western Medicine approaches.Practically,it establishes a seamless system—from molecular early-warning and dynamic prevention to tissue re-pair—supported by standardized protocols,preclinical validation,multi-center clinical trials,and an intelligent health management platform.

Chronic kidney disease(CKD)has a high prevalence rate.Its common complication,chronic kidney disease-mineral and bone disorder(CKD-MBD),has become an important factor af-fecting the long-term prognosis of patients.The pathogenesis of CKD-MBD is complex,involving mul-tiple mechanisms such as dysregulation of the Klotho-fibroblast growth factor 23(FGF23)-FGF recep-tor(FGFR)signaling pathway,calcium-phosphorus metabolism disorders,impaired synthesis of 1,25-dihydroxyvitamin D3[1,25-(OH)2D3],abnormal regulationof parathyroid hormone(PTH)secretion,and the involvement of the Wnt/β-catenin signaling pathway.Its pathological manifesta-tions not only include renal osteodystrophy but also involve in extraskeletal complications,such as vascular calcification and increased risk of cardiovascular events.Diabetes,as the most common cause of CKD,further exacerbates the development of CKD-MBD through various mechanisms,inclu-ding hyperglycemia,oxidative stress,activation of inflammatory factors,and bone microvascular dis-ease.In the population undergoing maintenance hemodialysis,there are differences in calcium-phos-phorus levels,PTH concentrations,and FGF23 expression patterns between diabetic nephropathy patients and non-diabetic CKD patients.However,the specific mechanisms underlying these changes have not been fully elucidated in large-scale epidemiological studies.This article aimed to review the basic research and clinical characteristics of CKD-MBD in diabetic nephropathy patients and non-diabetic CKD patients,with the hope of providing theoretical basis and practical guidance for future precision treatment.

Objective To investigate influencing factors of textbook outcome(TO)in patients with pancreatic ductal adenocarcinoma undergoing minimally invasive pancreaticoduodenectomy(MIPD).Methods A retrospective analysis was conducted on the clinical data of 101 cases of pancreatic ductal adenocarcinoma treated with MIPD in our hospital from January 2020 to December 2022.According to the inclusion and exclusion criteria,89 cases were ultimately included in this study,of which 61 cases reached TO(TO group)and 28 cases did not reach TO(non-TO group).Variables with P<0.05 in univariate analysis were included in multivariate logistic regression analysis to identify independent prognostic factors of TO.Results Univariate analysis showed that there were significant differences in pancreatic duct dilation>3 mm,preoperative neutrophil lymphocyte ratio(NLR),extended hospital stay,postoperative hospitalstay,and drain fluid amylase(DFA)>1100 U/L at1-3 d aftersurgery(P<0.05).Multivariate logistic regression analysis showed that the independent prognostic factors affecting TO were:pancreatic duct dilation>3 mm(OR=7.290,95%CI:1.485-35.786,P=0.014),postoperative hospital stay(OR=0.862,95%CI:0.751-0.989,P=0.034),and the DFA on the first postoperative day>1100 U/L(OR=0.052,95%CI:0.005-0.545,P=0.014).Conclusions The outcome of TO in patients after MIPD is not related to the surgical approach(robot assisted minimally invasive pancreaticoduodenectomy or laparoscopic pancreaticoduodenectomy).Pancreatic duct dilation>3 mm,postoperative hospital stay,and DFA on the first postoperative day>1100 U/L are independent prognostic factors of TO after MIPD in patients with pancreatic ductal adenocarcinoma.