Ferroptosis exhibits a clear “double-edged sword” effect in liver fibrosis， with its impact strictly dependent on the type of target cells. In hepatocytes， ferroptosis induced by specific signaling pathways （such as glutathione peroxidase 4 inhibition） is a key factor for driving hepatic injury and initiating fibrogenesis， and dying hepatocytes activate hepatic stellate cells by releasing damage-associated molecules； on the contrary， in activated hepatic stellate cells， ferroptosis becomes a therapeutic target for promoting liver fibrosis regression， and selective elimination can be achieved by disrupting their distinctive antioxidant defense mechanisms. Moreover， ferroptosis modulates the dynamic balance of the fibrotic liver microenvironment by regulating macrophage polarization and intercellular communication. Based on the above mechanisms， targeting ferroptosis has emerged as a promising strategy for precise treatment. This article summarizes related research advances and discusses the major challenges and future directions for clinical translation.

Digital simulation and three-dimensional (3D) printing technology-assisted treatment of mandibular fractures in children has good clinical application value. During the surgery, attention should be paid to the fixation of dentition defects, jawbone development, and the protection of permanent tooth germs. This article reports a case of a 7-year-old male patient with a mandibular chin fracture, treated with digital simulation of fracture reduction and 3D printing of mandible model, along with implantable occlusal splint, then underwent open reduction and internal fixation surgery. After 3 and 6 months, the 3D printed splint and internal fixation titanium plate were removed. The mandibular fracture healed well, without affecting jawbone development, and the tooth germs remained undamaged, the occlusal relationship recovered well. The case suggests the use of computer digital simulation and 3D printing technology facilitates precise reduction of mandibular fractures and reduces the impact on the jawbone and tooth germs, which provids valuable clinical reference.

Objective:To systematically evaluate and integrate the exercise experience of overweight or obese pregnant women during pregnancy, in order to provide basis for the formulation of standardized exercise programs for this population.Methods:We searched databases including PubMed, Cochrane Library, Web of Science, CINAHL, Embase, Ovid, PsycINFO, Chinese Biomedical Literature Database, VIP, Wanfang and China National Knowledge Infrastructure, from their inception to August 16, 2023, to collect qualitative studies on the exercise experience of overweight or obese pregnant women during pregnancy. The quality of included studies was evaluated according to Joanna Briggs Institute Critical Appraisal Tool for qualitative studies in Australia. The results were integrated by integrating methods.Results:A total of 11 studies were included. Sixty-one complete findings were grouped according to similarities to form 9 new categories. These categories resulted in 3 synthesized findings. Pregnant women with overweight or obesity were affected by promoting and hindering factors; careful balance of exercise risk and benefit for overweight or obese pregnant women during pregnancy; expectations and needs of overweight or obese pregnant women for exercise during pregnancy.Conclusions:Overweight or obese pregnant women highly rated the benefits and importance of exercise, but their participation and adherence to exercise is challenging. Medical staff should pay attention to the exercise experience of overweight or obese pregnant women during pregnancy, understand the driving factors and obstacles of exercise for overweight or obese pregnant women, in order to provide standardized and personalized exercise guidance programs for overweight or obese pregnant women.

Digital simulation and three-dimensional (3D) printing technology-assisted treatment of mandibular fractures in children has good clinical application value. During the surgery, attention should be paid to the fixation of dentition defects, jawbone development, and the protection of permanent tooth germs. This article reports a case of a 7-year-old male patient with a mandibular chin fracture, treated with digital simulation of fracture reduction and 3D printing of mandible model, along with implantable occlusal splint, then underwent open reduction and internal fixation surgery. After 3 and 6 months, the 3D printed splint and internal fixation titanium plate were removed. The mandibular fracture healed well, without affecting jawbone development, and the tooth germs remained undamaged, the occlusal relationship recovered well. The case suggests the use of computer digital simulation and 3D printing technology facilitates precise reduction of mandibular fractures and reduces the impact on the jawbone and tooth germs, which provids valuable clinical reference.

Objective:To explore the training experiences of palliative care nurses participating in a prognosis disclosure workshop based on Kolb's experiential learning model, and to provide references for future educational programs in palliative care nursing.Methods:Using purposive sampling, 11 nurses were recruited who had participated in the "Palliative Care Competency Training Program for Nurses" in Shanghai between March and May 2025 and selected the Third Affiliated Hospital of Naval Medical University as their clinical training site. Semi-structured interviews were conducted, and data were analyzed using Colaizzi's seven-step method.Results:A total of three major themes emerged: a sense of benefit from enhanced competencies; complex emotional experiences; recommendations for course optimisation.Conclusions:Workshops based on Kolb's experiential learning model offer positive value in palliative care education. They effectively improve core competencies such as communication and empathy. However, the emotional experiences of nurses must also be considered, and multifaceted optimizations to the training design are recommended to further enhance training outcomes.

Background and purpose:Intracellular deubiquitylating enzymes,such as ubiquitin-specific peptidase 2(USP2),play a pivotal role in regulating protein degradation and cellular homeostasis by modulating protein ubiquitin deconjugation,which have been implicated in the proliferation and survival of multiple myeloma(MM)cells.Targeting the inhibition of USP2 activity in MM cells might modulate their biological behavior.This study aimed to investigate regulatory effects of the leukotriene receptor antagonist montelukast sodium on USP2 in MM cells and its subsequent biological effects.Methods:An in vitro deubiquitination reaction system was established using purified USP2 protein and its substrate,the glutathione S-transferase(GST)tagged ubiquitin A-52 residue ribosomal protein fusion product(UbA52),known as GST-UbA52 protein.This system was used to characterize inhibitory effects of montelukast sodium on USP2 deubiquitinase activity.The MM cell lines MM1.S and H929 were used as in vitro models.Cellular thermal shift assay(CETSA)was subsequently employed to test interaction mode between montelukast sodium and USP2 in MM cells.Western blot assay was applied to detect expression levels of USP2 and its targeting regulators,including cell cycle supervisors cyclin D1(CCND1)and cyclin A1(CCNA1),classical signaling transducer KRAS and glucose regulated protein 78kD(GRP78),as well as apoptotic molecule C/EBP-homologous protein(CHOP)in MM1.S and H929 cells before and after the treatment with different concentrations of montelukast sodium.MM cells with either overexpression(H929-OE,MM1.S-OE)or knockdown(H929-LE,MM1.S-LE)of USP2 were generated using a lentiviral vector.Cell counting kit-8(CCK-8)and flow cytometry were utilized to detect the proliferation and apoptotic rates of H929-OE,MM1.S-OE,H929-LE and MM1.S-LE cells treated with montelukast sodium.Results:Montelukast sodium was found to inhibit USP2 mediated degradation of GST-UbA52 protein in a concentration-dependent manner,with a half inhibitory concentration(IC50)of 3.814 μmol/L.Additionally,montelukast sodium significantly enhanced the thermal stability of USP2 at temperatures of 49.1,53.2 and 56.4℃.It was also shown that montelukast sodium could down-regulate expressions of CCND1,CCNA1 and KRAS,while increase levels of GRP78 and CHOP in MM1.S and H929 cells.Furthermore,after treating with 40 μmol/L montelukast sodium for 24 h,the proliferation inhibition and apoptotic rate of H929-OE cells reached to(37.68±1.10)%and(18.99±0.26)%,while the proliferation inhibition and apoptotic rate of MM1.S-OE cells reached to(24.48±0.49)%and(33.29±0.75)%,which were significantly lower than those in H929 and MM1.S cells[H929:(57.19±1.93)%and(45.65±0.24)%;MM1.S:(50.04±0.53)%and(40.25±0.91)%;P＜0.05,n=3].Conversely,the proliferation inhibition and apoptotic rates of H929-LE and MM1.S-LE cells were significantly higher[H929-LE-1#:(80.70±1.60)%and(89.08±0.49)%;H929-LE-2#:(75.30±3.80)%and(82.41±1.07)%;MM1.S-LE-1#:(70.64±0.84)%and(67.63±0.21)%;MM1.S-LE-2#:(68.47±1.32)%and(85.90±0.18)%;P＜0.05,n=3].Conclusion:Montelukast sodium can target ubiquitin proteasome regulator USP2 and inhibit its deubiquitylating activity,which may modulate USP2 directing protein and trigger endoplasmic reticulum stress to induce cell cycle arrest and apoptosis in MM cells.

Objective:To systematically evaluate and integrate the exercise experience of overweight or obese pregnant women during pregnancy, in order to provide basis for the formulation of standardized exercise programs for this population.Methods:We searched databases including PubMed, Cochrane Library, Web of Science, CINAHL, Embase, Ovid, PsycINFO, Chinese Biomedical Literature Database, VIP, Wanfang and China National Knowledge Infrastructure, from their inception to August 16, 2023, to collect qualitative studies on the exercise experience of overweight or obese pregnant women during pregnancy. The quality of included studies was evaluated according to Joanna Briggs Institute Critical Appraisal Tool for qualitative studies in Australia. The results were integrated by integrating methods.Results:A total of 11 studies were included. Sixty-one complete findings were grouped according to similarities to form 9 new categories. These categories resulted in 3 synthesized findings. Pregnant women with overweight or obesity were affected by promoting and hindering factors; careful balance of exercise risk and benefit for overweight or obese pregnant women during pregnancy; expectations and needs of overweight or obese pregnant women for exercise during pregnancy.Conclusions:Overweight or obese pregnant women highly rated the benefits and importance of exercise, but their participation and adherence to exercise is challenging. Medical staff should pay attention to the exercise experience of overweight or obese pregnant women during pregnancy, understand the driving factors and obstacles of exercise for overweight or obese pregnant women, in order to provide standardized and personalized exercise guidance programs for overweight or obese pregnant women.

Objective:To systematically evaluate the effect of the Dietary Approaches to Stop Hypertension (DASH) diet on common metabolic diseases.Methods:Following the PICOS framework to construct the search formula, we systematically searched the Web of science, PubMed, Cochrane Library, CNKI, Wanfang, and VIP databases for randomized controlled trials (RCTs) investigating the effect of the DASH diet on multiple metabolic indices including body weight, body mass index (BMI), fasting blood glucose, triglycerides, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in patients with metabolic disorders (e.g., obesity, diabetes mellitus, and hypertension) published both in China and abroad from 1 January 2000 to 31 December 2023. The search terms were combinations of MeSH and free-text terms, and the raw data obtained from the search were screened according to the inclusion and exclusion criteria to determine the articles that were finally included in the analysis. The differences in these metabolic indices were compared between the intervention group group (using DASH diet) and the control group. The quality of the studies was assessed quantitatively using the modified Jadad scale and qualitatively using the Risk of Bias 2 (RoB 2) tool by two reviewers independently. Data analysis was conducted using Stata 18.0 software, with the I 2 test for heterogeneity evaluation and funnel plots for qualitative assessment of publication bias. Results:A total of 13 RCTs were included, involving 1 653 participants. Meta-analysis showed that the intervention group had more favorable effects on SBP ( SMD:-0.91, 95%CI: -1.55–-0.27; Z=-2.79, P<0.005) and DBP ( SMD: -0.98, 95%CI: -1.62–-0.33; Z=-2.96, P<0.05) than the control diet. Fasting blood glucose ( SMD: 0.21, 95% CI: 0.01–0.41; Z=2.06, P=0.04) was statistically significant. There were no significant differences in body weight, BMI, fasting blood glucose, and triglyceride outcomes betweeen these two groups. Conclusions:DASH diet is effective in controlling SBP and DBP in patients with metabolic disorders and may be useful in clinical adjunctive therapy. However, current evidence does not support an independent improvement in glycolipid metabolic markers.

Objective To investigate the causal relationship between gut microbiota and obstruc-tive sleep apnea syndrome(OSA)using a two-sample bidirectional Mendelian randomization(MR)approach.Methods Eligible single nucleotide polymorphisms(SNPs)were selected from genome-wide association study(GWAS)databases as instrumental variables.A bidirectional MR analysis was conducted to evaluate the causal effects between gut microbiota and OSA.Various statistical methods,including the inverse variance weighted(IVW)method,MR-Egger regression,the weighted model method,and the weighted median method,were employed for association assessment.The MR pleiot-ropy residual sum and outlier(MR-PRESSO)test,along with Cochran's Q test and the leave-one-out cross-validation method,were used to assess heterogeneity and pleiotropy.Results According to the IVW method analysis,an increased abundance of the genus Faecalibacterium(sp002397985)(OR=0.847,95％CI,0.719 to 0.997,P=0.046)was associated with a reduced risk of OSA.Conversely,increased abundances of the genera Bacteroides(OR=1.075,95％CI,1.016 to 1.138,P=0.012),Haemophilus(sp001679485)(OR=1.106,95％CI,1.016 to 1.203,P=0.021),Streptococcus(OR=1.168,95％CI,1.036 to 1.316,P=0.011),and Blautia(sp002159835)(OR=1.169,95％CI,1.035 to 1.319,P=0.012)were associated with an elevated risk of OSA.The reverse MR analysis revealed no significant association between the risk of OSA and the abundance of gut microbiota.The results of Cochran's Q test,MR-Egger test,and MR-PRESSO test indicated no het-erogeneity or horizontal pleiotropy(P＞0.05).Conclusion Causal relationships exist between the five genera(Faecalibacterium,Bacteroides,Haemophilus,Streptococcus,and Blautia)and the risk of OSA.

Military training represents one of the most essential activities for troops during peacetime,of which the prevention and treatment of training-induced injuries are a very important part.Recent findings of research suggest that cold atmospheric plasma(CAP)exhibits a distinctive and multifaceted superiority in terms of broad-spectrum sterilization,rapid blood coagulation and healing promotion for wounds.Consequently,CAP has good prospects of applications in diverse fields such as clinical medicine,emergency rescue and military medicine.Based on a review of the research progress in plasma medicine,the applicability of CAP in the prevention and treatment of military training injuries was discussed in this paper by focusing on the urgent issues related to military training injury,including the typical application scenarios and methods for CAP,the safety and effectiveness of plasma trauma prevention and treatment,and the key issues facing the prevention and treatment of military training injuries.