1.Interpretation of advances in immune therapy for non-small cell lung cancer at the 2025 European Lung Cancer Congress
Wen LIU ; Jiayu LU ; Xuxu ZHANG ; Xinyao XU ; Jipeng ZHANG ; Wei LI ; Guizhen LI ; Bo BAO ; Qiang LU
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2025;32(08):1063-1071
		                        		
		                        			
		                        			The 2025 European Lung Cancer Congress (ELCC) convened in Paris, France, centering on the optimization and innovation of immunotherapy for non-small cell lung cancer (NSCLC). Key topics at the congress included the application strategies for perioperative immunotherapy, breakthroughs in combination therapy models for advanced NSCLC, and the emerging roles of biomarkers in predicting diverse treatment outcomes. This paper integrates data from several key pivotal studies to systematically analyze the clinical value of neoadjuvant therapy within the perioperative setting, the potential of targeted combination regimens, and the challenges of managing drug resistance, thus offering new directions for clinical practice.
		                        		
		                        		
		                        		
		                        	
2.Correlation analysis of serum SIRT1 and Vasostatin-2 content with pathological changes in diabetic retinopathy patients
Qing DONG ; Bo LIU ; Xingyuan BAO ; Jing WEI
International Eye Science 2025;25(6):962-967
		                        		
		                        			
		                        			 AIM: To investigate the correlation of serum Silent mating-type information regulation 2 homolog 1(SIRT1)and Vasostatin-2 content with pathological changes in diabetic retinopathy(DR)patients.METHODS: A total of 104 DR patients(104 eyes)admitted to our hospital from April 2021 to April 2024 were included as the DR group. According to different disease stages, they were assigned into a non-proliferative DR(NPDR)group of 44 cases(44 eyes)and a proliferative DR(PDR)group of 60 cases(60 eyes). Meantime, 104 patients(104 eyes)with simple diabetes were treated as non-DR group. ELISA was applied to detect the levels of SIRT1 and Vasostatin-2 in serum. The diagnostic value of serum SIRT1 and Vasostatin 2 in DR was analyzed by ROC curve. Multivariate Logistic regression was applied to analyze the factors that affected the occurrence of DR. Pearson correlation was applied to analyze the relationship between the levels of SIRT1 and Vasostatin-2 in the serum of DR patients and angiogenesis indicators(VEGF, Ang-2).RESULTS: Compared with the non-DR group, the levels of SIRT1 and Vasostatin-2 in the serum of the DR group were significantly decreased(P<0.05). Compared with the NPDR group, the levels of SIRT1 and Vasostatin-2 in the serum of the PDR group were significantly decreased(P<0.05). Compared with the non-DR group, the levels of VEGF and Ang-2 in the serum of the DR group were obviously higher(P<0.05). Compared with the single detection of serum SIRT1 and Vasostatin-2 levels, combined detection significantly increased the AUC in the diagnosis of DR(Z=4.180, 5.128, all P<0.05). Multivariate Logistic regression analysis showed that HOMA-IR(OR=3.455), fasting blood glucose(OR=1.467), SIRT1(OR=0.836), Vasostatin-2(OR=0.767), VEGF(OR=2.564), and Ang-2(OR=1.834)levels were the influencing factors on the occurrence of DR(all P<0.05). Pearson correlation analysis showed that the levels of SIRT1 and Vasostatin-2 in the serum of DR patients were negatively correlated with VEGF and Ang-2(rSIRT1 vs VEGF=-0.395, rSIRT1 vs Ang-2=-0.474, rVasostatin-2 vs VEGF=-0.323, rVasostatin-2 vs Ang-2=-0.583, all P<0.001).CONCLUSION: The abnormal decrease of serum SIRT1 and Vasostatin 2 levels in DR patients is closely related to the stage of DR lesions and angiogenesis. 
		                        		
		                        		
		                        		
		                        	
3.GOLM1 promotes cholesterol gallstone formation via ABCG5-mediated cholesterol efflux in metabolic dysfunction-associated steatohepatitis livers
Yi-Tong LI ; Wei-Qing SHAO ; Zhen-Mei CHEN ; Xiao-Chen MA ; Chen-He YI ; Bao-Rui TAO ; Bo ZHANG ; Yue MA ; Guo ZHANG ; Rui ZHANG ; Yan GENG ; Jing LIN ; Jin-Hong CHEN
Clinical and Molecular Hepatology 2025;31(2):409-425
		                        		
		                        			 Background/Aims:
		                        			Metabolic dysfunction-associated steatohepatitis (MASH) is a significant risk factor for gallstone formation, but mechanisms underlying MASH-related gallstone formation remain unclear. Golgi membrane protein 1 (GOLM1) participates in hepatic cholesterol metabolism and is upregulated in MASH. Here, we aimed to explore the role of GOLM1 in MASH-related gallstone formation. 
		                        		
		                        			Methods:
		                        			The UK Biobank cohort was used for etiological analysis. GOLM1 knockout (GOLM1-/-) and wild-type (WT) mice were fed with a high-fat diet (HFD). Livers were excised for histology and immunohistochemistry analysis. Gallbladders were collected to calculate incidence of cholesterol gallstones (CGSs). Biles were collected for biliary lipid analysis. HepG2 cells were used to explore underlying mechanisms. Human liver samples were used for clinical validation. 
		                        		
		                        			Results:
		                        			MASH patients had a greater risk of cholelithiasis. All HFD-fed mice developed MASH, and the incidence of gallstones was 16.7% and 75.0% in GOLM1-/- and WT mice, respectively. GOLM1-/- decreased biliary cholesterol concentration and output. In vivo and in vitro assays confirmed that GOLM1 facilitated cholesterol efflux through upregulating ATP binding cassette transporter subfamily G member 5 (ABCG5). Mechanistically, GOLM1 translocated into nucleus to promote osteopontin (OPN) transcription, thus stimulating ABCG5-mediated cholesterol efflux. Moreover, GOLM1 was upregulated by interleukin-1β (IL-1β) in a dose-dependent manner. Finally, we confirmed that IL-1β, GOLM1, OPN, and ABCG5 were enhanced in livers of MASH patients with CGSs. 
		                        		
		                        			Conclusions
		                        			In MASH livers, upregulation of GOLM1 by IL-1β increases ABCG5-mediated cholesterol efflux in an OPN-dependent manner, promoting CGS formation. GOLM1 has the potential to be a molecular hub interconnecting MASH and CGSs. 
		                        		
		                        		
		                        		
		                        	
4.GOLM1 promotes cholesterol gallstone formation via ABCG5-mediated cholesterol efflux in metabolic dysfunction-associated steatohepatitis livers
Yi-Tong LI ; Wei-Qing SHAO ; Zhen-Mei CHEN ; Xiao-Chen MA ; Chen-He YI ; Bao-Rui TAO ; Bo ZHANG ; Yue MA ; Guo ZHANG ; Rui ZHANG ; Yan GENG ; Jing LIN ; Jin-Hong CHEN
Clinical and Molecular Hepatology 2025;31(2):409-425
		                        		
		                        			 Background/Aims:
		                        			Metabolic dysfunction-associated steatohepatitis (MASH) is a significant risk factor for gallstone formation, but mechanisms underlying MASH-related gallstone formation remain unclear. Golgi membrane protein 1 (GOLM1) participates in hepatic cholesterol metabolism and is upregulated in MASH. Here, we aimed to explore the role of GOLM1 in MASH-related gallstone formation. 
		                        		
		                        			Methods:
		                        			The UK Biobank cohort was used for etiological analysis. GOLM1 knockout (GOLM1-/-) and wild-type (WT) mice were fed with a high-fat diet (HFD). Livers were excised for histology and immunohistochemistry analysis. Gallbladders were collected to calculate incidence of cholesterol gallstones (CGSs). Biles were collected for biliary lipid analysis. HepG2 cells were used to explore underlying mechanisms. Human liver samples were used for clinical validation. 
		                        		
		                        			Results:
		                        			MASH patients had a greater risk of cholelithiasis. All HFD-fed mice developed MASH, and the incidence of gallstones was 16.7% and 75.0% in GOLM1-/- and WT mice, respectively. GOLM1-/- decreased biliary cholesterol concentration and output. In vivo and in vitro assays confirmed that GOLM1 facilitated cholesterol efflux through upregulating ATP binding cassette transporter subfamily G member 5 (ABCG5). Mechanistically, GOLM1 translocated into nucleus to promote osteopontin (OPN) transcription, thus stimulating ABCG5-mediated cholesterol efflux. Moreover, GOLM1 was upregulated by interleukin-1β (IL-1β) in a dose-dependent manner. Finally, we confirmed that IL-1β, GOLM1, OPN, and ABCG5 were enhanced in livers of MASH patients with CGSs. 
		                        		
		                        			Conclusions
		                        			In MASH livers, upregulation of GOLM1 by IL-1β increases ABCG5-mediated cholesterol efflux in an OPN-dependent manner, promoting CGS formation. GOLM1 has the potential to be a molecular hub interconnecting MASH and CGSs. 
		                        		
		                        		
		                        		
		                        	
5.GOLM1 promotes cholesterol gallstone formation via ABCG5-mediated cholesterol efflux in metabolic dysfunction-associated steatohepatitis livers
Yi-Tong LI ; Wei-Qing SHAO ; Zhen-Mei CHEN ; Xiao-Chen MA ; Chen-He YI ; Bao-Rui TAO ; Bo ZHANG ; Yue MA ; Guo ZHANG ; Rui ZHANG ; Yan GENG ; Jing LIN ; Jin-Hong CHEN
Clinical and Molecular Hepatology 2025;31(2):409-425
		                        		
		                        			 Background/Aims:
		                        			Metabolic dysfunction-associated steatohepatitis (MASH) is a significant risk factor for gallstone formation, but mechanisms underlying MASH-related gallstone formation remain unclear. Golgi membrane protein 1 (GOLM1) participates in hepatic cholesterol metabolism and is upregulated in MASH. Here, we aimed to explore the role of GOLM1 in MASH-related gallstone formation. 
		                        		
		                        			Methods:
		                        			The UK Biobank cohort was used for etiological analysis. GOLM1 knockout (GOLM1-/-) and wild-type (WT) mice were fed with a high-fat diet (HFD). Livers were excised for histology and immunohistochemistry analysis. Gallbladders were collected to calculate incidence of cholesterol gallstones (CGSs). Biles were collected for biliary lipid analysis. HepG2 cells were used to explore underlying mechanisms. Human liver samples were used for clinical validation. 
		                        		
		                        			Results:
		                        			MASH patients had a greater risk of cholelithiasis. All HFD-fed mice developed MASH, and the incidence of gallstones was 16.7% and 75.0% in GOLM1-/- and WT mice, respectively. GOLM1-/- decreased biliary cholesterol concentration and output. In vivo and in vitro assays confirmed that GOLM1 facilitated cholesterol efflux through upregulating ATP binding cassette transporter subfamily G member 5 (ABCG5). Mechanistically, GOLM1 translocated into nucleus to promote osteopontin (OPN) transcription, thus stimulating ABCG5-mediated cholesterol efflux. Moreover, GOLM1 was upregulated by interleukin-1β (IL-1β) in a dose-dependent manner. Finally, we confirmed that IL-1β, GOLM1, OPN, and ABCG5 were enhanced in livers of MASH patients with CGSs. 
		                        		
		                        			Conclusions
		                        			In MASH livers, upregulation of GOLM1 by IL-1β increases ABCG5-mediated cholesterol efflux in an OPN-dependent manner, promoting CGS formation. GOLM1 has the potential to be a molecular hub interconnecting MASH and CGSs. 
		                        		
		                        		
		                        		
		                        	
6.A Retrospective Study on the Qianyang Fengsui Dan Combined with Flying Needle Therapy in the Treatment of Kidney-Yang Deficiency Type of Insomnia
Hong-Yan YANG ; Bao-Ting XU ; Ling-Ling DONG ; Xiu-Hong LIU ; Yuan-Min LI ; Qing-Bo MIAO ; Chao-Peng LIU
Journal of Guangzhou University of Traditional Chinese Medicine 2024;41(3):664-670
		                        		
		                        			
		                        			Objective To analyze the clinical efficacy of the Qianyang Fengsui Dan(combined with flying needle therapy)in the treatment of kidney-yang deficiency type of insomnia.Methods A retrospective study was conducted to select 82 patients with insomnia admitted to the Department of Traditional Chinese Medicine of Dezhou Hospital of Traditional Chinese Medicine from November 2020 to November 2021,and they were divided into an observation group and a control group according to whether or not they were treated with Qianyang Fengsui Dan combined with flying needle therapy,with 41 cases in each group.The control group was treated with Estazolam,while the observation group was treated with Qianyang Fengsui Dan combined with flying needle therapy on the basis of the treatment of the control group,and the course of treatment was 1 month.The changes of Pittsburgh Sleep Quality Index(PSQI)scores and Epworth Sleepiness Scale(ESS)scores,as well as polysomnographic parameters were observed before and after treatment in the two groups.The changes of γ-aminobutyric acid(GABA),glutamate(GA),substance P(SP),and neuropeptide Y(NPY)levels were compared before and after treatment between the two groups.And followed up for 1 year to compare the incidence of relapce of the two groups of patients.Results(1)The total effective rate was 95.12%(39/41)in the observation group and 63.41%(26/41)in the control group,and the efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P<0.05).(2)After treatment,PSQI scores and ESS scores of patients in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving PSQI scores and ESS scores,and the differences were statistically significant(P<0.05).(3)After treatment,sleep efficiency,awakening time,sleep latency,REM,and total sleep time were significantly improved in the two groups(P<0.05),and the observation group was significantly superior to the control group in improving sleep efficiency,awakening time,sleep latency,REM,and total sleep time,and the differences were statistically significant(P<0.05).(4)After treatment,the serum GABA,GA,SP,and NPY levels of patients in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving the serum GABA,GA,SP,and NPY levels,and the differences were all statistically significant(P<0.05).(5)After treatment,follow-up for 1 year,the recurrence rate of the observation group was 0,and there were 7 cases of recurrence in the control group,and the recurrence rate of the control group was 17.07%(7/41),and the recurrence rate of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion The combination of flying needle therapy and Qianyang Fengsui Dan can effectively relieve insomnia and fatigue in patients with insomnia,reduce daytime drowsiness,regulate the release of blood monoamine neurotransmitters,and reduce the relapse rate,and its efficacy is superior to that of simple western medicine treatment.
		                        		
		                        		
		                        		
		                        	
7.Expression of CRKL in intrahepatic cholangiocarcinoma and its effect on the proliferation and invasion of cholangiocarci-noma cells
Wen-Lei KUO ; Xin-Yue BAO ; Jing-Bo CHANG ; Qi SUN ; Li-Min WEI
Chinese Journal of Current Advances in General Surgery 2024;27(9):684-688
		                        		
		                        			
		                        			Objective:To investigate the expression of kinase-like gene CT10 regulatory fac-tor(CRKL)in intrahepatic cholangiocarcinoma(ICC)and its effect on the proliferation and invasion of intrahepatic cholangiocarcinoma cells.Methods:qRT-PCR detected CRKL transcription in ICC pa-tient tissues and adjacent tissues.Immunohistochemistry assessed CRKL expression in ICC tissues and adjacent tissues,and analyzed its relationship with clinicopathological features.For the inhibition of CRKL expression in QBC939 cells by siRNA technology,the effect of CRKL silencing on AKT and ERK signaling pathway was measured by Western blot.CRKL's influence on QBC939 cell prolifera-tion and invasion was analyzed by MTT,clonogenesis,and Transwell assays.Results:The expres-sion of CRKL in ICC tissues was up-regulated,and there were statistically significant differences in CRKL expression in ICC with different clinicopathological features such as tumor size,lymph node metastasis and TNM stage.Cellular experiments showed a significant decrease in the phosphoryla-tion of AKT and ERK upon inhibition of CRKL,and the proliferation and invasion ability of ICC cells was significantly diminished(P<0.05).Conclusion:CRKL promotes ICC cell proliferation and invasion through AKT and ERK pathways,offering new molecular targets and directions for targeted therapy.
		                        		
		                        		
		                        		
		                        	
8.Efficacy and Mechanism of Lutongning Granules in Treatment of Trigeminal Neuralgia Induced by Injection of Talc into Infraorbital Foramen of Model Rats Based on P2X7R-mediated Neuroinflammation
Qiyue SUN ; Shuran LI ; Shuangrong GAO ; Shanshan GUO ; Zihan GENG ; Lei BAO ; Ronghua ZHAO ; Jingsheng ZHANG ; Bo PANG ; Yingli XU ; Yu ZHANG ; Shan CAO ; Yaxin WANG ; Xiaolan CUI ; Bing HAN ; Jing SUN
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(15):56-63
		                        		
		                        			
		                        			ObjectiveTo evaluate the effectiveness of Lutongning granules in the treatment of trigeminal neuralgia in animal models and study its mechanism of action, so as to provide laboratory data support for the clinical application of Lutongning granules and precise treatment. MethodMale SD rats were randomly divided into normal group, model group, carbamazepine group (0.06 g·kg-1·d-1), high-dose Lutongning group (2.70 g·kg-1·d-1), and low-dose Lutongning group (1.35 g·kg-1·d-1) according to the stratified basic mechanical pain thresholds, with 10 rats in each group. A trigeminal neuralgia model of rats was prepared by injecting 30% talc suspension into the infraorbital foramen area of the rat. The drug groups were administered 10 mL·kg-1 of drugs by gavage after 2 h of modeling. The normal group and the model group were administered distilled water by gavage under the same conditions once a day for 10 consecutive days. Von Frey brushes were used to determine the mechanical pain threshold of rats. A fully automated blood and body fluid analyzer was employed to detect the blood routine of rats. Hematoxylin and eosin (HE) staining was utilized to detect the pathological changes in the trigeminal ganglion and medulla oblongata tissue. Transmission electron microscopy was used to scan the ultrastructure of the medulla oblongata tissue. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of inflammatory factors interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor (TNF)-α, neuropeptide substance P, and β-endorphins (β-EP) in the serum of rats, and Western blot was used to detect the protein expression levels of IL-1β, purinergic receptor P2X7 (P2X7R), and phosphorylated p38 mitogen-activated protein kinase (p-p38 MAPK). ResultCompared with that in the normal group, the pain threshold of rats in the model group was significantly lower (P<0.01). The absolute value of neutrophils (NEUT#) and the percentage of neutrophils (NEUT) were significantly improved, and the percentage of lymphocytes (LYMPH) was significantly reduced (P<0.01). The serum levels of IL-1, IL-6, IL-8, and TNF-α were significantly increased (P<0.01). SP content in brain tissue was significantly increased, and β-EP content was significantly decreased (P<0.01). The relative protein expression of IL-1β, P2X7R, and p-p38 MAPK was significantly increased (P<0.05). HE staining and transmission electron microscopy results of medulla oblongata tissue revealed neuronal degeneration, mild proliferation of microglial cells, reduction in the number of myelinated nerves, and obvious demyelination. The trigeminal nerve fibers of rats were disarranged, and some nerve fibers showed vacuolization. Axons were swollen, and Schwann cells proliferated. Demyelination was observed. Compared with the model group, each administration group significantly increased the pain threshold of rats (P<0.05, P<0.01), reduced NEUT# and NEUT, and elevated LYMPH (P<0.05, P<0.01). The administration group significantly decreased the levels of IL-1, IL-6, IL-8, and TNF-α in serum and SP in brain tissue (P<0.01) and increased the level of β-EP (P<0.01). They significantly down-regulated the protein expression of IL-1β, P2X7R, and p-p38 MAPK(P<0.05, P<0.01) and significantly ameliorated the pathological changes in medulla oblongata tissue and trigeminal nerves of rats. ConclusionLutongning Granules had significant therapeutic effects on trigeminal neuralgia induced by injection of talc into the infraorbital foramen of model rats, and the mechanism may be related to amelioration of P2X7R-mediated neuroinflammation and inhibition of demyelination of myelinated nerves. 
		                        		
		                        		
		                        		
		                        	
9.Effect of Influenza A Virus on BEAS-2B in Human Lung Epithelial Cells and Intervention Effect of Shufeng Jiedu Capsule-containing Serum
Shan CAO ; Zihan GENG ; Lei BAO ; Yingli XU ; Bo PANG ; Jingsheng ZHANG ; Yu ZHANG ; Mengping CHEN ; Yaxin WANG ; Ronghua ZHAO ; Shanshan GUO ; Xiaolan CUI
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(23):90-97
		                        		
		                        			
		                        			ObjectiveTo observe the effect of Shufeng Jiedu capsule (SFJD)-containing serum on human lung epithelial cells infected by influenza A virus, and investigate the protective effect of the drug on the cells and the potential antiviral effect. MethodThe SFJD-containing serum was prepared and used to treat human lung epithelial cells (BEAS-2B) cultured in vitro. The viability of cells treated with different concentrations of SFJD-containing serum was measured by the cell counting kit-8 (CCK-8), and the optimal concentration of SFJD-containing serum was screened for subsequent experiments. BEAS-2B cells were classified into normal control, virus infection, and SFJD-containing serum groups, and the CCK-8 method was used to detect the survival rate of BEAS-2B cells after virus infection and drug administration. The expression of influenza virus nucleic acid in the cells of each group was determined, and the apoptosis of cells in different groups was observed by fluorescence microscopy. Real-time PCR was employed to determine the mRNA levels of influenza virus nucleoprotein (NP), Toll-like receptor 4 (TLR4), and myeloid differentiation primary response gene 88 (MyD88) in each group of cells. The immunofluorescence assay was used to detect the fluorescence intensities of TLR4, MyD88, and phosphorylated nuclear factor-κB (p-NF-κB) in lung epithelial cells. ResultCompared with that in the control group (normal serum), the cell survival rates in the blank serum and the SFJD-containing serum (5%, 10%, and 20%) groups were 100.00%±0.00%, 89.05%±4.80%, 87.13%±5.90%, 93.83%±6.03%, and 99.33%±3.39%, respectively (P<0.01). The SFJD-containing serum of 20% was selected as the optimal treatment for subsequent experiments. Compared with the normal control group, the virus infection group showed reduced cell survival rate (P<0.01), and the reduction was increased by the SFJD-containing serum (P<0.01). Compared with the virus infection group, SFJD-containing serum reduced the virus load (P<0.01) to decrease apoptosis. Compared with the normal control group, the virus infection group showed up-regulated mRNA levels of NP, TLR4, and MyD88 (P<0.01), and the up-regulation was down-regulated by the SFJD-containing serum (P<0.05, P<0.01). The fluorescence intensities of TLR4, MyD88, and p-NF-κB proteins in the cells increased after virus infection compared with those in the normal control (P<0.05, P<0.01), and they were decreased after administration with the SFJD-containing serum (P<0.05). ConclusionThe SFJD-containing serum can inhibit influenza virus in vitro by increasing the survival rate, reducing the apoptosis, and down-regulating the protein levels of TLR4, MyD88, and p-NF-κB in BEAS-2B cells. 
		                        		
		                        		
		                        		
		                        	
10.Association between Metal(loid)Exposure and Risk of Polycystic Ovary Syndrome Mediated by Anti-Müllerian Hormone among Women Undergoing In Vitro Fertilization and Embryo Transfer
Su SHU ; Ren MENGYUAN ; Feng YANQIU ; Lan CHANGXIN ; Yan LAILAI ; Lu QUN ; Xu JIA ; Han BIN ; Zhuang LILI ; Fang MINGLIANG ; Wang BIN ; Bao HONGCHU ; Pan BO
Biomedical and Environmental Sciences 2024;37(10):1107-1116
		                        		
		                        			
		                        			Objective To investigate the relationship and potential pathways between metal(loid)exposure and the risk of polycystic ovary syndrome(PCOS)in women of childbearing age. Methods This case-control study included 200 patients with PCOS(cases)and 896 non-PCOS controls with the age of 25-37 years.The concentrations of 29 metal(loid)s in the follicular fluid(FF)and clinical indicators in the serum were measured in all participants.Logistic regression analysis and mediation analysis were conducted to evaluate the associations between metal(loid)exposure and PCOS risk and investigate the possible roles of clinical indicators,respectively. Results Logistic regression analysis revealed an association between high copper levels in FF and increased PCOS risk(highest vs.lowest quartile:adjusted odds ratio=2.94,95%confidence interval:1.83-4.72).A high luteinizing hormone/follicle-stimulating hormone ratio and elevated levels of testosterone and anti-Müllerian hormone(AMH)were strongly associated with increased PCOS risk induced by high copper exposure.The mediation analysis indicated a mediating effect of AMH in the association between copper exposure and PCOS risk. Conclusion Copper may affect PCOS risk through the hypothalamic-pituitary-ovarian axis,mediated by AMH.Copper exposure and internal AMH levels are important indicators for early warning of PCOS development.
		                        		
		                        		
		                        		
		                        	
            
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