Metabolic reprogramming plays a crucial role in the pathogenesis of cardiovascular diseases(CVD).Lactate,a metabolite of glycolysis,is now considered an important cellular signaling molecule involved in regulating various metabolic processes within the microenvironment.Recently discovered lactylation modifications have been found to play significant roles in CVD such as atherosclerosis(As),vascular or valve calcification,myocardial infarction,heart failure(HF),and pulmonary hypertension(PH).This review summarizes the regulatory mechanisms of lactate and lactylation modifications in these CVD,aiming to provide new insights for their precise prevention and treatment strategies.

Pulmonary fibrosis is a chronic progressive parenchymal lung lesion that is a common outcome of several interstitial lung diseases.Despite some progress in investigation of the etiology and pathogenesis of pulmonary fibrosis,it only achieves palliation and is difficult to cure.Lung macrophages are the most abundant innate immune cells in alveolar tissues,and there exists a great degree of heterogeneity and potential dynamic changes of lung macrophages at different stages of pulmonary fibrosis,whose dysfunction is closely related to the development of pulmonary fibrosis.Macrophages in the early stage of lung tissue injury mainly mediate the inflam-matory response.However,in the fibrotic stage,macrophages would be transformed into macrophages with a reparative phenotype that secrete large amounts of pro-fibrotic mediators and promote the proliferation and differentiation of fibroblasts,contributing to the pro-gression and deterioration of pulmonary fibrosis.The function of lung macrophages during fibrosis is regulated by a variety of mecha-nisms,including epigenetic modifications,metabolic reprogramming,and regulation of complex signaling pathways,etc.Strict func-tional regulation is critical for maintaining lung homeostasis and regulating injury repair.In this review,we will describe the heteroge-neity of macrophage and the underlying regulatory mechanisms during pulmonary fibrosis.

Objective To evaluate the impact of lens capsule diameter and capsular tension ring(CTR)fit on the ro-tational stability and visual function of Toric intraocular lenses(IOLs)in patients with high myopia cataract after surgery,and to explore the main influencing factors.Methods A prospective study included 100 eyes of patients with high myopia(axial length≥26 mm)who underwent phacoemulsification cataract extraction combined with Toric IOL implantation at the Cataract Department of Hebei Eye Hospital from September 2023 to March 2024.Based on the ratio of the capsule equivalent diameter measured by anterior segment OCT(CASIA2)to the standard diameter of CTR,the eyes were divided into the matched group(ratio of 0.8-1.2)and the unmatched group.Follow-up was conducted at 1 week,1 month,3 months,6 months,and 12 months postoperatively to observe the rotation angle of Toric IOL,residual astigmatism,uncor-rected visual acuity,and other indicators.Safety was assessed based on intraoperative and postoperative complications.Correlation analysis and multiple linear regression were used to explore the impact of capsule-CTR fit,corneal astigmatism,axial length,and other factors on Toric IOL rotation and postoperative refractive status.Results The mean IOL rotation angle at each postoperative time point in the matched group was significantly smaller than that in the unmatched group,with statistically significant differences between groups at different time points(all P＜0.05).The matched group showed better stability in IOL decentration distance and tilt angle.At 12 months postoperatively,the residual astigmatism in the matched group was(0.53±0.29)D,which was better than that in the unmatched group(0.71±0.34)D(P=0.08).The matched group also had more significant improvement in uncorrected visual acuity and higher subjective visual quality scores.Multiple linear regression analysis showed that capsule-CTR fit and preoperative corneal astigmatism were the main independent factors affecting the rotation angle of Toric IOL(R2=0.52)and residual astigmatism(R2=0.46).Conclu-sion For patients with high myopia cataract,precise capsule-CTR matching based on CASIA2 measurement helps improve the rotational stability of Toric IOLs,reduce residual astigmatism,and enhance postoperative visual quality.Personalized CTR model selection is worth promoting and applying.

Metabolic reprogramming plays a crucial role in the pathogenesis of cardiovascular diseases(CVD).Lactate,a metabolite of glycolysis,is now considered an important cellular signaling molecule involved in regulating various metabolic processes within the microenvironment.Recently discovered lactylation modifications have been found to play significant roles in CVD such as atherosclerosis(As),vascular or valve calcification,myocardial infarction,heart failure(HF),and pulmonary hypertension(PH).This review summarizes the regulatory mechanisms of lactate and lactylation modifications in these CVD,aiming to provide new insights for their precise prevention and treatment strategies.

Objective To evaluate the impact of lens capsule diameter and capsular tension ring(CTR)fit on the ro-tational stability and visual function of Toric intraocular lenses(IOLs)in patients with high myopia cataract after surgery,and to explore the main influencing factors.Methods A prospective study included 100 eyes of patients with high myopia(axial length≥26 mm)who underwent phacoemulsification cataract extraction combined with Toric IOL implantation at the Cataract Department of Hebei Eye Hospital from September 2023 to March 2024.Based on the ratio of the capsule equivalent diameter measured by anterior segment OCT(CASIA2)to the standard diameter of CTR,the eyes were divided into the matched group(ratio of 0.8-1.2)and the unmatched group.Follow-up was conducted at 1 week,1 month,3 months,6 months,and 12 months postoperatively to observe the rotation angle of Toric IOL,residual astigmatism,uncor-rected visual acuity,and other indicators.Safety was assessed based on intraoperative and postoperative complications.Correlation analysis and multiple linear regression were used to explore the impact of capsule-CTR fit,corneal astigmatism,axial length,and other factors on Toric IOL rotation and postoperative refractive status.Results The mean IOL rotation angle at each postoperative time point in the matched group was significantly smaller than that in the unmatched group,with statistically significant differences between groups at different time points(all P＜0.05).The matched group showed better stability in IOL decentration distance and tilt angle.At 12 months postoperatively,the residual astigmatism in the matched group was(0.53±0.29)D,which was better than that in the unmatched group(0.71±0.34)D(P=0.08).The matched group also had more significant improvement in uncorrected visual acuity and higher subjective visual quality scores.Multiple linear regression analysis showed that capsule-CTR fit and preoperative corneal astigmatism were the main independent factors affecting the rotation angle of Toric IOL(R2=0.52)and residual astigmatism(R2=0.46).Conclu-sion For patients with high myopia cataract,precise capsule-CTR matching based on CASIA2 measurement helps improve the rotational stability of Toric IOLs,reduce residual astigmatism,and enhance postoperative visual quality.Personalized CTR model selection is worth promoting and applying.

Pulmonary fibrosis is a chronic progressive parenchymal lung lesion that is a common outcome of several interstitial lung diseases.Despite some progress in investigation of the etiology and pathogenesis of pulmonary fibrosis,it only achieves palliation and is difficult to cure.Lung macrophages are the most abundant innate immune cells in alveolar tissues,and there exists a great degree of heterogeneity and potential dynamic changes of lung macrophages at different stages of pulmonary fibrosis,whose dysfunction is closely related to the development of pulmonary fibrosis.Macrophages in the early stage of lung tissue injury mainly mediate the inflam-matory response.However,in the fibrotic stage,macrophages would be transformed into macrophages with a reparative phenotype that secrete large amounts of pro-fibrotic mediators and promote the proliferation and differentiation of fibroblasts,contributing to the pro-gression and deterioration of pulmonary fibrosis.The function of lung macrophages during fibrosis is regulated by a variety of mecha-nisms,including epigenetic modifications,metabolic reprogramming,and regulation of complex signaling pathways,etc.Strict func-tional regulation is critical for maintaining lung homeostasis and regulating injury repair.In this review,we will describe the heteroge-neity of macrophage and the underlying regulatory mechanisms during pulmonary fibrosis.

Objective To investigate the expression of serum levels of small mothers against decapentaplegic homolog 2(SMAD2)and tumor necrosis factor receptor-related associated factor 3(TRAF3)in patients with lupus nephritis(LN)and their correlation with prognosis.Methods A total of 150 patients with LN(LN group)and 80 patients with systemic lupus erythema-tosus(SLE)without nephritis(non-LN group)treated at Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to March 2023 were selected.Patients with LN were followed up for 1 year and divided into the poor progno-sis group(n=61)and the good prognosis group(n=89).Serum levels of SMAD2 and TRAF3 were measured using enzyme-linked immunosorbent assay(ELISA).Multivariate unconditional logistic regression was used to identify factors affecting poor progno-sis in LN patients,and receiver operating characteristic(ROC)curves were constructed to evaluate the predictive efficacy of se-rum SMAD2 and TRAF3 levels for LN prognosis.Results Compared with the non-LN group,serum SMAD2(5.34±1.16ng/ml vs 2.98±1.11ng/ml)and TRAF3(91.23±12.58ng/L vs 74.38±11.91ng/L)levels were significantly elevated in the LN group,and the differences were statistically significant(t=14.917,9.852,all P＜0.05).During the 1-year follow-up,the incidence of poor prognosis among the 150 LN patients was 40.67%(61/150).Compared with the good prognosis group,serum SMAD2(6.03±1.02ng/ml vs 4.86±1.00ng/ml)and TRAF3(98.65±10.49ng/L vs 86.15±11.35ng/L)levels were significantly higher in the poor prognosis group,and the differences were statistically significant(t=7.015,6.830,all P＜0.05).The independent risk factors for poor prognosis in LN patients were advanced chronic kidney disease stage,elevated SMAD2 and elevated TRAF3,while the independent protective factor was increased estimated glomerular filtration rate(eGFR)(Wald χ2=9.633～16.666,all P＜0.05).The area under the curve(AUC)of predicting poor prognosis in LN patients by serum SMAD2 and TRAF3 levels was larger than that predicted by serum SMAD2 alone and TRAF3 levels alone,and the differences were statistically significant(Z=3.658,3.606,all P＜0.05).Conclusion Elevated serum SMAD2 and TRAF3 levels in LN patients are closely associated with poor prognosis.The combination of serum SMAD2 and TRAF3 levels has high predictive efficacy for poor prognosis in LN patients.

Objective: To design and establish a new method for flow cytometry-based detection of commonly observed highly expressed antigens on red blood cells, and to further evaluate the differences and distribution characteristics of antigen expression levels between ABO blood type homozygotes and heterozygotes in healthy individuals. Methods: Residual blood samples after donor blood type identification by Shanghai Blood Center in April 2024 were collected. Among them, samples of 19 homozygous and 19 heterozygous individuals of type A and type B were selected. Then the expression level of ABO antigen on red blood cells were detected using the new method established in this study and the traditional aldehyde fixed red blood cell method. Both methods were tested independently three times and the results were compared. Results: The mean values of the three detection results of the new method was (×10 /RBC): AA homozygous 3.3±0.5, AO heterozygous 2.8±0.3, BB homozygous 3.6±0.3, BO heterozygous 3.1±2.8. The mean values of the three detection results of the aldehyde fixation method were AA homozygous 5.9±0.9, AO heterozygous 5.0±1.4, BB homozygous 3.8±0.6, and BO heterozygous 3.3±0.4. The average antigen distribution of each genotype followed a normal distribution. Comparing the average antigen expression levels of homozygotes and heterozygotes, both methods showed that A/B homozygotes had higher antigen levels than heterozygotes, with AA being 1.17 to 1.18 times that of AO and BB being 1.15 to 1.16 times that of BO. Comparing the inter batch differences in the three test results of two methods, the new method showed no significant difference in the three test results for four genotypes (P>0.05). The aldehyde fixation method showed significant differences in the test results for all three genotypes (P<0.01) except for BB homozygotes (P>0.05). The reliability and reproducibility of the new method were better than those of the traditional aldehyde fixation method. Conclusion: The antigen expression level of ABO homozygotes is higher than that of heterozygotes, and the difference in antigen level between type A homozygotes and heterozygotes is slightly higher than that of type B. The new method is superior to traditional aldolization fixation methods.

ObjectiveTo investigate the application of the novel inflammatory factor adsorption column CA280 combined with low-dose plasma exchange （LPE） in patients with acute-on-chronic liver failure （ACLF）. MethodsA prospective cohort study was designed， and a total of 93 ACLF patients who were admitted to The Ninth Hospital of Nanchang from June 2023 to January 2025 were enrolled and randomly divided into DPMAS+LPE group with 50 patients and CA280+LPE group with 43 patients. In addition to comprehensive medical treatment， the patients in the DPMAS+LPE group received DPMAS and LPE treatment， and those in the CA280+LPE group received CA280 and LPE treatment. The two groups were observed in terms of routine blood test results， liver function parameters， renal function markers， electrolytes， coagulation function parameters， cytokines， adverse events， and 28-day prognosis before surgery （baseline）， during surgery （DPMAS or CA280）， and after surgery （after sequential LPE treatment）. The paired t-test was used for comparison of normally distributed continuous data before and after treatment within each group， and the independent-samples t test was used for comparison between groups； the Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment within each group， and the Mann-Whitney U test was used for comparison between groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups， and the Spearman test was used for correlation analysis. ResultsAfter CA280 treatment， the ACLF patients had significant reductions in the levels of cytokines （IL-6， IL-8， IL-10， TNF-α， and IFN-γ）， liver function parameters （ALT， AST， ALP， TBil， DBil， Alb， and glutathione reductase）， and the renal function marker urea nitrogen （all P<0.05）， and in terms of coagulation function parameters， there were significant increases in prothrombin time， activated partial thromboplastin time （APTT）， thrombin time， and international normalized ratio （INR） and significant reductions in prothrombin activity （PTA） and fibrinogen （FIB） （all P<0.05）. Compared with the DPMAS+LPE group， the CA280+LPE group showed better improvements in the serum cytokines IL-8 （Z=-2.63， P=0.009）， IL-10 （Z=-3.94， P<0.001）， and TNF-α （Z=-1.53， P=0.023）， and the two artificial liver support systems had a similar effect in improving liver function （ALT， AST， GGT， GR， TBil， and DBil） （all P >0.05）， but the CA280+LPE group showed a significantly greater reduction in Alb （Z=-2.08， P=0.037）. CA280+LPE was more effective in reducing uric acid （Z=-2.97， P=0.003）. Compared with DPMAS+LPE， CA280+LPE treatment resulted in a significant reduction in INR （Z=-4.01， P<0.001）， a significant increase in APTT （Z=-2.53， P=0.011）， and significant greater increases in PTA （Z=-6.28， P<0.001） and FIB （Z=-3.93， P<0.001）. There were no significant differences in the incidence rates of adverse reactions and the rate of improvement at discharge between the two groups （all P>0.05）. The Spearman correlation analysis showed that IL-6 was significantly correlated with WBC （r=0.22， P=0.042）， TBil （r=0.29， P=0.005）， and FIB （r=-0.33， P=0.003）； IL-8 was positively correlated with APTT （r=0.37， P<0.001） and INR （r=0.25， P=0.013）； TNF-α was significantly correlated with WBC （r=0.40， P<0.001） and TBil （r=0.34， P<0.001）. ConclusionCompared with DPMAS， CA280 combined with LPE can effectively clear proinflammatory cytokines and improve liver function in ACLF patients， but it has a certain impact on Alb and coagulation function. This regimen provides a new option for the individualized treatment of ACLF and can improve the short-term prognosis of patients， but further studies are needed to verify its long-term efficacy.

Objective:To investigate the effects of Xiaomudan Granules on PERK/eIF2α/ATF4 pathway and lipid metabolism in NAFLD mice.Methods:Totally 60 mice were divided into a normal group of 10 mice and a high-fat diet group of 50 mice. The high-fat diet group was given a high-fat diet to establish a NAFLD mouse model. The high-fat feed group was divided into model group, metformin group, and Xiaomudan Granules low-, medium-, and high-dosage groups according to the random number table method. Xiaomudan Granules low-, medium-, and high-dosage groups were orally administered with concentrated Xiaomudan Granules at dosages of 11.7, 23.4, and 46.8 g/kg, respectively. The metformin group was orally administered with metformin solution at a dose of 0.2 g/kg, while the normal group and model group were orally administered with distilled water of equal volume once a day for 8 consecutive weeks. The liver oil red O staining of mice was observed in each group. The protein expressions of p-PERK, p-eIF2α, ATF4, C/EBP homologous protein (CHOP), CCAAT enhancer binding protein alpha (C/EBPα), C/EBPβ, and steroid regulatory element binding protein 2 (SREBP2) were detected by Western blot. Fluorescence quantitative PCR was used to detect the mRNA expressions of ATF4, CHOP, C/EBPα, C/EBPβ, and SREBP2.Results:The liver tissue structure and steatosis of mice were improved in Xiaomudan Granules groups. Compared with the model group, the expressions of p-PERK/PERK, ATF4, C/EBPα, C/EBPβ, and SREBP2 proteins decreased in Xiaomudan Granules groups and the metformin group ( P<0.01 or P<0.05). The expressions of p-eIF2α/eIF2α and CHOP proteins decreased in the Xiaomudan Granules medium- and high-dosage groups and the metformin group ( P<0.01); compared with the model group, the levels of ATF4, CHOP, C/EBPα, and C/EBPβ mRNA in Xiaomudan Granules groups and the metformin group decreased ( P<0.01), while the levels of SREBP2 mRNA in the Xiaomudan Granules medium- and high-dosage groups and the metformin group decreased ( P<0.01). Conclusion:Xiaomudan Granules may improve liver lipid metabolism and reduce liver fat deposition in NAFLD mice by regulating the PERK/eIF2α/ATF4 pathway.