BACKGROUND:The self-renewal and multi-directional differentiation of pluripotent stem cells possess the potential to revolutionize people's understanding of biology,medicine,development,and disease.Stem cells play an important role in the early stage of embryonic development,and the study of them could be beneficial to understanding of the basic principles of biological development and tissue or organ formation,exploring the potential mechanisms of various diseases,studying the repair and regeneration of damaged tissues or organs,and promoting drug discovery and personalized treatment. OBJECTIVE:To review the research progress of pluripotent stem cells,summarize and categorize the fundamental types of pluripotent stem cells,and elucidate the lineage situations of various types of pluripotent stem cells in common mammals. METHODS:PubMed,Web of Science,CNKI,and WanFang databases were searched systematically,with the keywords"pluripotent stem cells;embryonic stem cells;induced pluripotent stem cells;expanded potential stem cells;livestock pluripotent stem cells"in English and Chinese.The 99 articles related to mammalian pluripotent stem cells were systematically screened according to inclusion and exclusion criteria,and then reviewed. RESULTS AND CONCLUSION:(1)According to classical theory in mouse embryonic stem cell research,the pluripotent state of stem cells is divided into two forms:na?ve and primed.Na?ve state corresponds to the inner cell mass of pre-implantation embryos before attachment to the uterine wall,while primed state corresponds to the epiblast after implantation.These two states exhibit significant differences in epigenetic features,transcriptional activity,external signal dependency,and metabolic phenotype.It is later discovered that there is an intermediate state between na?ve and primed called formative pluripotency.Therefore,the pluripotency of pluripotent stem cells is a continuous developmental process rather than a unique cell state.(2)In addition to obtaining pluripotent stem cells from the inner cell mass,there are various methods and lineages for acquiring pluripotent stem cells,including embryonic germ cells established using primitive germ cells from mouse embryos,induced pluripotent stem cells created by the dedifferentiation of adult mouse and human fibroblasts with four factors—Oct3/4,Sox2,c-Myc,and Klf4;embryonic stem cell-like cell lines cultured from somatic cell nuclear transfer,parthenogenesis,neonatal or adult testicular or ovarian tissue,very small embryonic-like stem cells derived from various adult tissues and expanded pluripotent stem cells derived from pre-implantation stages.These pluripotent stem cells all share the common characteristics of continuous self-renewal,expressing core pluripotency factors and possessing the ability to differentiate into the three primary germ layers.(3)Currently,pluripotent stem cells are being used for disease modeling to study the mechanisms of various diseases and develop new drugs.Simultaneously,scientists are attempting to use pluripotent stem cells to cultivate various tissues and organs,offering new possibilities for regenerative medicine and transplantation.However,the clinical application of pluripotent stem cells faces safety challenges,including issues of cell mutations and immune rejection.Continual improvement in the methods of generating pluripotent stem cells will make them safer and more efficient for clinical applications.(4)Based on the methods of obtaining and lineage establishment of pluripotent stem cells in mice and humans,various types of pluripotent stem cells have been established in livestock,including embryonic stem cells,induced pluripotent stem cells,germ lineages of pluripotent stem cells,and expanded potential stem cells.Research on livestock pluripotent stem cells opens up new avenues for animal reproduction,breeding,genetic engineering,disease modeling,drug screening,and the conservation of endangered wildlife.

Objective To analyze challenges in translating exercise management evidence for patients with metabolism-associated fatty liver disease(MAFLD),develop actionable strategies,and evaluate the application of best evidence.Methods Utilizing the evidence translation model,the best evidence was implemented for MAFLD patients in 4 phases:evidence acquisition,baseline practice review,intervention,and outcome evaluation.We compared the knowledge of exercise management evidence,implementation rates of review indicators,completion of exercise programs,BMI,liver stiffness measurement,controlled attenuation parameters,and patient satisfaction among medical staff at a tertiary hospital in Fujian Province during baseline(March-May 2023),mid-practice(June-August 2023),and late-practice(September-November 2023)phases.Results A total of 88 patients were included at baseline review,95 during mid-practice,and 107 in late-practice.Significant improvements were observed in the implementation rates of 21 review indicators,nurses'knowledge,completion rate,BMI,and controlled attenuation parameters compared to the data at baseline(P＜0.05).Conclusion The application of best evidence in exercise management for MAFLD patients enhances nurses'knowledge,standardizes nursing practices,and reduces patients'BMI and controlled attenuation parameters.

Objective:To evaluate the effect of an obstetric artificial intelligence (AI) assistant combined with a family-centered health education model on maternal self-care ability, comfort status, and spousal caregiving ability.Methods:This prospective, single-center, parallel randomized controlled trial used 1∶1 randomization and was conducted as a superiority trial. Postpartum mothers and their spouses admitted to family-style single rooms at the Third Affiliated Hospital of Guangzhou Medical University between October 2024 and April 2025 were enrolled and randomly assigned to control or intervention groups using a random number table. The control group received conventional health education, while the intervention group received conventional health education plus the AI-assisted family-centered model. Interventions were administered at 2 hours, 6 hours, and 24 hours postpartum, and before discharge. Outcomes included maternal self-care ability, comfort status, and spousal caregiving ability, which were assessed at 2 hours postpartum and before discharge. Data were analyzed using independent and paired t-tests and Chi square tests. Results:Of the 88 mother-spouse dyads initially recruited, four were excluded due to mother-infant separation (e.g., neonatal jaundice), leaving 84 dyads (42 per group). After the intervention, the intervention group showed significantly higher maternal self-care ability scores [(192.81±13.80) vs. (181.00±21.41) scores, t=3.00], higher maternal comfort scores [(104.43±7.52) vs. (96.00±14.29) scores, t=3.38], and better spousal caregiving ability [(6.07±3.13) vs. (9.50±5.02) scores, t=－3.76] compared to the control group (all P<0.05). Conclusion:The obstetric AI assistant combined with a family-centered health education model significantly improved maternal self-care ability and comfort status, as well as spousal caregiving ability.

Objective A randomized controlled trial was conducted on colonoscopy inpatient and outpatients to compare the efficacy and safety of water exchange(WE)colonoscopy and CO2 convention insufflation colonoscopy in elderly patients.Methods 340 patients underwent fully sedated colonoscopy were randomly divided into two groups according to colonoscopy with either WE colonoscopy group(WE group)and CO2 insufflation colonoscopy group(CO2 group).The two groups were compared in terms of Boston bowel preparation scale(BBPS),withdrawal time,cecal intubation time,cecal intubation success rate,abdominal compression,willingness to repeat,polypdetectionrate(PDR),adenoma detection rate(ADR),and safety.Results The cecal intubation success rate was significantly higher in WE group(100.0%)compared with CO2 group(96.5%),the difference was statistically significant(P=0.013).The average cecal intubation time of WE group was(10.50±1.79)min,which was longer than that of CO2 group(7.55±1.50)min,and the difference was statistically significant(P<0.01).Comparison of withdrawal time and BBPS between the two groups,the differences were not statistically significant(P>0.05).The abdominal pressure rate was lower in WE group(5.9%)compared with CO2 group(13.5%),the difference was statistically significant(P=0.017).The rate of willingness to re-examination in the WE group was 98.2%,which was significantly higher than the 93.5%in the CO2 group.The PDR in WE group(80.6%)was higher than that in CO2 group(70.6%),the ADR in WE group(67.1%)was higher than that in CO2 group(50.6%),the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that WE group was an effective factor in improving ADR(O＾R=2.027,P<0.01).The overall adverse events were less than 3%,with no difference between the two groups(P=1.000).Conclusion The use of WE colonoscopy has a better improved efficacy in elderly patients,and safety should be ensured by individualized assessment of the patient's co-morbidities,bowel preparation tolerance,and willingness prior to the procedure.

Objective To investigate the therapeutic efficacy of artesunate(AS)on polycystic ovary syndrome(PCOS)in mice and explore the potential mechanism primarily.Methods Twenty-five female C57BL/6J mice were randomly divided into Control group,model group(PCOS group),low-and high-dose AS groups(AS15 and AS30 groups)and metformin group(Met group).In addition to the Control group,the mouse model of PCOS was established by subcutaneous injection of dehydroepiandrosterone(DHEA,60 mg/kg)following by a high-fat diet for 21 d.After modeling,AS of 15 and 30 mg/kg was intraperitoneally injected into the mice of the AS 15 and AS30 groups,respectively,and 200 mg/kg Met was given to those of the Met group by gavage,once per day,for 6 weeks.ELISA was used to detect serum testosterone(T),fasting insulin(FINS),luteinizing hormone(LH)and follicle-stimulating hormone(FSH),and the LH/FSH ratio was calculated.The levels of fasting blood glucose(FBG),triglyceride(TG)and total cholesterol(TC)were detected by automatic biochemical analyzer,and the homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.The estrous cycle was observed,and HE staining was performed for pathological changes in the ovary and uterus.Immunofluorescence assay was employed to measure the expression of p-eIF2α,ATF4 and CHOP in the ovarian tissue.After steroidogenic human granulosa-like tumor cell line KGN were exposed to 100 μmol/L DHEA to simulate the hyperandrogen environment of PCOS,and then treated with 5 and 10 μg/mL AS for 24 h,the protein levels of endoplasmic reticulum stress signaling pathway was detected by Western blotting.Results Compared with the Control group,the PCOS mice had disturbed estrous cycle,polycystic changes in the ovaries,and significantly increased serum T level and LH/FSH ratio(P＜0.05),and obviously elevated HOMA-IR,TC and TG levels in terms of metabolism(P＜0.01).The expression levels of p-eIF2α,ATF4 and CHOP were notably up-regulated in the ovarian granulosa cells of PCOS mice and KGN cells after DHEA exposure(P＜0.05).Additionally,AS treatment attenuated the pathological changes of ovary and uterine expression,decreased the serum T level and the LH/FSH ratio(P＜0.05),and reduced HOMA-IR,TC and TG levels(P＜0.05)when compared with the PCOS mice.Moreover,the expression levels of p-eIF2α,ATF4 and CHOP were significantly down-regulated after AS treatment in both ovarian granulosa cells of PCOS mice and KGN cells(P＜0.05).Conclusion AS significantly improves glycolipid metabolic disorder and reproductive dysfunction in PCOS mice,which may be associated with its suppressing endoplasmic reticulum stress by inhibiting the PERK/eIF2α/ATF4/CHOP pathway.

Objective To develop a machine learning model integrating preoperative chest CT radiomic features with clinical data for predicting 5-year postoperative recurrence risk in stage Ⅰ non-small cell lung cancer(NSCLC)patients undergoing surgical resection.Methods A total of 217 patients with pathologically confirmed stage Ⅰ NSCLC(selected from 778 initially screened cases based on our inclusion and exclusion criteria)treated in Army Medical Center of PLA between January 2014 and December 2019 were retrospectively enrolled,including 53 recurrence cases and 164 non-recurrence cases within 5-year follow-up.They were randomly divided into a training set(n=173)and a validation set(n=44)in a ratio of 8:2.Radiomic models were established based on extracted features from tumor-dominant regions of interest(ROI)on CT images,while clinical models were developed using demographic characteristics and preoperative laboratory examinations.A combined model was further constructed by integrating both feature sets,and model performance was compared to identify the optimal predictive model.Results This study screened the features from non-contrast CT images and ultimately selected 7 radiomic features for constructing radiomic model.Among 6 machine learning algorithms,the adaptive boosting(Adaboost)model demonstrated the best overall predictive performance,with an area under the curve(AUC)of 0.866(95%CI:0.808～0.923;accuracy:0.832,specificity:0.884)in the training set and of 0.806(95%CI:0.630～0.983;accuracy:0.795,specificity:0.971)in the validation set.Univariate and multivariate logistic regression analyses identified 4 clinical features for clinical model construction.The clinical model achieved an AUC value of 0.874(95%CI:0.821～0.928;accuracy:0.827,specificity:0.891)in the training set and 0.813(95%CI:0.677～0.948;accuracy:0.636,specificity:0.600)in the validation set.By integrating the 7 radiomic features and 4 clinical features using a feature-level fusion strategy,the combined model exhibited further improved predictive performance,with an AUC value of 0.953(95%CI:0.924～0.983;accuracy:0.884,specificity:0.860)and 0.852(95%CI:0.729～0.976;accuracy:0.682,specificity:0.629),respectively in the training set and the validation set.Conclusion The combined model integrating preoperative CT radiomic features with clinical risk factors may provide an evidence-based framework for evaluating 5-year postoperative recurrence risk in stage Ⅰ NSCLC patients.

Objective A randomized controlled trial was conducted on colonoscopy inpatient and outpatients to compare the efficacy and safety of water exchange(WE)colonoscopy and CO2 convention insufflation colonoscopy in elderly patients.Methods 340 patients underwent fully sedated colonoscopy were randomly divided into two groups according to colonoscopy with either WE colonoscopy group(WE group)and CO2 insufflation colonoscopy group(CO2 group).The two groups were compared in terms of Boston bowel preparation scale(BBPS),withdrawal time,cecal intubation time,cecal intubation success rate,abdominal compression,willingness to repeat,polypdetectionrate(PDR),adenoma detection rate(ADR),and safety.Results The cecal intubation success rate was significantly higher in WE group(100.0%)compared with CO2 group(96.5%),the difference was statistically significant(P=0.013).The average cecal intubation time of WE group was(10.50±1.79)min,which was longer than that of CO2 group(7.55±1.50)min,and the difference was statistically significant(P<0.01).Comparison of withdrawal time and BBPS between the two groups,the differences were not statistically significant(P>0.05).The abdominal pressure rate was lower in WE group(5.9%)compared with CO2 group(13.5%),the difference was statistically significant(P=0.017).The rate of willingness to re-examination in the WE group was 98.2%,which was significantly higher than the 93.5%in the CO2 group.The PDR in WE group(80.6%)was higher than that in CO2 group(70.6%),the ADR in WE group(67.1%)was higher than that in CO2 group(50.6%),the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that WE group was an effective factor in improving ADR(O＾R=2.027,P<0.01).The overall adverse events were less than 3%,with no difference between the two groups(P=1.000).Conclusion The use of WE colonoscopy has a better improved efficacy in elderly patients,and safety should be ensured by individualized assessment of the patient's co-morbidities,bowel preparation tolerance,and willingness prior to the procedure.

Objective To analyze challenges in translating exercise management evidence for patients with metabolism-associated fatty liver disease(MAFLD),develop actionable strategies,and evaluate the application of best evidence.Methods Utilizing the evidence translation model,the best evidence was implemented for MAFLD patients in 4 phases:evidence acquisition,baseline practice review,intervention,and outcome evaluation.We compared the knowledge of exercise management evidence,implementation rates of review indicators,completion of exercise programs,BMI,liver stiffness measurement,controlled attenuation parameters,and patient satisfaction among medical staff at a tertiary hospital in Fujian Province during baseline(March-May 2023),mid-practice(June-August 2023),and late-practice(September-November 2023)phases.Results A total of 88 patients were included at baseline review,95 during mid-practice,and 107 in late-practice.Significant improvements were observed in the implementation rates of 21 review indicators,nurses'knowledge,completion rate,BMI,and controlled attenuation parameters compared to the data at baseline(P＜0.05).Conclusion The application of best evidence in exercise management for MAFLD patients enhances nurses'knowledge,standardizes nursing practices,and reduces patients'BMI and controlled attenuation parameters.

Objective:To evaluate the effect of an obstetric artificial intelligence (AI) assistant combined with a family-centered health education model on maternal self-care ability, comfort status, and spousal caregiving ability.Methods:This prospective, single-center, parallel randomized controlled trial used 1∶1 randomization and was conducted as a superiority trial. Postpartum mothers and their spouses admitted to family-style single rooms at the Third Affiliated Hospital of Guangzhou Medical University between October 2024 and April 2025 were enrolled and randomly assigned to control or intervention groups using a random number table. The control group received conventional health education, while the intervention group received conventional health education plus the AI-assisted family-centered model. Interventions were administered at 2 hours, 6 hours, and 24 hours postpartum, and before discharge. Outcomes included maternal self-care ability, comfort status, and spousal caregiving ability, which were assessed at 2 hours postpartum and before discharge. Data were analyzed using independent and paired t-tests and Chi square tests. Results:Of the 88 mother-spouse dyads initially recruited, four were excluded due to mother-infant separation (e.g., neonatal jaundice), leaving 84 dyads (42 per group). After the intervention, the intervention group showed significantly higher maternal self-care ability scores [(192.81±13.80) vs. (181.00±21.41) scores, t=3.00], higher maternal comfort scores [(104.43±7.52) vs. (96.00±14.29) scores, t=3.38], and better spousal caregiving ability [(6.07±3.13) vs. (9.50±5.02) scores, t=－3.76] compared to the control group (all P<0.05). Conclusion:The obstetric AI assistant combined with a family-centered health education model significantly improved maternal self-care ability and comfort status, as well as spousal caregiving ability.

Celastrol, a pentacyclic triterpenoid compound derived from the root of Chinese herb Tripterygium wilfordii Hook.f.,can inhibit the growth of various types of malignant tumors. However, it still has some limitations, including high toxicity, poor water solubility, and low targeting efficiency. Therefore, structural modification of celastrol has become a research hotspot in recent years. The structural modifications of celstrol reported have focused on C-20-COOH and C-2, C-3, C-6 or multiple sites of AB ring. This review provides an overview of the research progress of anti-tumor celastrol derivatives in recent years according to different structural modification sites and purposes, such as enhancing the inhibitory effect on the Hsp90-Cdc37 protein-protein interaction, and modification methods, including principles of parallelism and targeting specific sites. In addition, it briefly discusses the antitumor activity, mechanism of action, and structure-activity relationship of these derivatives, aiming to provide theoretical guidance for the discovery of new celastrol derivatives with high efficiency, low toxicity, and strong selectivity.