Female reproductive health depends on the tightly coordinated regulation of ovarian function, embryonic development and the microenvironment at maternal-fetal interface. This review summarizes the molecular mechanism and improvement strategies of ovarian aging, the regulatory mechanism of glucose and lipid metabolism during early embryonic development, and the regulatory mechanism of the immune microenvironment during embryo implantation. Key aspects include: the mechanism of ovarian aging such as telomere shortening, oxidative stress, and mitochondrial dysfunction, along with the potential intervention strategies like rapamycin, exogenous nicotinamide adenine dinucleotide supplementation and small molecule natural medicine. During the early embryonic development, glucose and lipid metabolites such as acetyl CoA participate in regulating gene expression or serve as substrates for histone acetylation to regulate early embryonic development, and the regulation of endometrial receptivity by natural killer cells and T cells during embryo implantation. A deep understanding of the interaction among these regulatory mechanisms is of great significance for developing targeted therapy strategies and maintaining female reproductive health.

Objective To investigate the effect and potential mechanism of salvianolic acid B (SALB) extracted from salvia miltiorrhiza in ameliorating the aging process by modulating ovarian antioxidant capacity. Methods (1) In vitro experiments: a hydrogen peroxide (H₂O₂)-induced senescence model was established using human ovarian granulosa cell line (KGN), and the effective concentration of H₂O₂ was determined. KGN cells were treated with SALB at varying concentrations and durations. Cell viability was assessed via CCK-8 assay to determine the optimal concentration and treatment time of SALB. Treated KGN cells were divided into the control group (H₂O₂) and the experimental group (H₂O₂ + SALB). Levels of reactive oxygen species (ROS) and malondialdehyde (MDA) were measured. In vivo experiments: forty 9-month-old female mice were randomly assigned to the aged group and the treatment group (n=20 each), while an additional 20 2-month-old mice were used as the young group. The treatment group received intraperitoneal injections of SALB at 40 mg/kg. The young group and the aged group received equivalent doses of normal saline via intraperitoneal injection. Ovarian reserve was evaluated by counting antral follicles via hematoxylin and eosin (HE) staining. Serum levels of estradiol (E2) and follicle-stimulating hormone (FSH) were measured using enzyme-linked immunosorbent assay (ELISA). The estrous cycle was monitored via vaginal smears. Results (1) Treatment with 300 μmol/L H₂O₂ for 12 hours significantly reduced cell viability, inhibited proliferation and induced senescence in KGN cells. Treatment with 20 μmol/L SALB for 12 hours began to show effects, effectively counteracting H₂O₂-induced senescence in KGN cells and significantly reducing intracellular ROS and MDA levels (P<0.05). (2) In vivo results showed that, compared to the young group mice, mice of the aged group exhibited a significant reduction in antral follicle count and serum E2 levels, along with elevated FSH levels (P<0.05), and marked disruption of the estrous cycle. In contrast, mice in the treatment group demonstrated increased antral follicle counts and E2 levels, as well as reduced FSH levels compared to the aged group (P<0.05). There were no significant differences in these indicators between the treatment group and the young group. Moreover, the estrous cycle exhibited regular patterns in the treatment group. Conclusion SALB may exert antioxidant efficacy by scavenging ROS and inhibiting lipid peroxidation, thereby effectively alleviating senescence in ovarian granulosa cells, restoring ovarian reserve, normalizing estrous cycle irregularities, and ameliorating hormonal imbalances.

Objective To investigate the clinical significance of peripheral blood natural killer cells (pNKC) in women with unexplained recurrent implantation failure (URIF) and to evaluate the effect of oral prednisone on pregnancy outcomes in this population. Methods A retrospective analysis was conducted on 373 URIF patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment at two tertiary hospitals. Patients were divided into two groups based on the proportion of pNKC in peripheral blood lymphocytes: the normal pNKC group (<18%, 202 cases) and the high pNKC group (≥18%, 171 cases). Patients were categorized by prednisone use: the prednisone group of 211 cases (including 123 cases of high pNKC and 88 cases of normal pNKC) and the control group of 162 cases (including 48 cases of high pNKC and 114 cases of normal pNKC). Whether pNKC concentration was associated with embryo implantation was analyzed. Whether prednisone administration positively affected pregnancy outcomes in URIF patients was also analyzed. Results Compared with the normal pNKC group, there were no significant differences in live birth rate, clinical pregnancy rate or miscarriage rate in the high pNKC group (P > 0.05). In URIF patients with normal pNKC levels, no significant difference was observed in pregnancy outcomes between the control group and the prednisone group (P > 0.05). In URIF patients with high pNKC levels, the clinical pregnancy rate was higher in the prednisone group than that of the control group (P<0.05), but there were no significant differences in live birth rate or miscarriage rate between the two groups (P > 0.05). Conclusion Women with URIF show a relatively high proportion of pNKC counts. The pNKC levels have no significant impact on pregnancy outcome in URIF patients. Oral prednisone may offer potential benefits for URIF patients with high pNKC levels.

Pathological mechanisms of endometrial disorders, including endometriosis, endometrial carcinoma and chronic endometritis are complex. The intestinal flora, as the most important micro-ecosystem in human body, plays a key role in material metabolism, immune regulation and neuroendocrine control. The homeostasis of the female reproductive tract microbiota has been proven to be the foundation for maintaining reproductive health. The "gut-organ axis" theory has driven attention to microecological interaction between the intestinal and reproductive tract microbiota. This review surveys current microecological research on the interplay between endometrial pathologies and alterations, and systematically sorts out the crosstalk mechanism of intestinal and reproductive tract microbiota in occurrence and development of endometrial diseases. Finally, the article explores the key functional microbiota and related regulatory pathways, and looks forward to the potential strategies for the transformation and application from microecological theory to clinical practice.

Metabolic reprogramming is a pivotal event driving oocyte maturation and early embryonic development, the success of which directly determines female reproductive potential and the outcomes of assisted reproductive technology (ART). This review focuses on the dynamic regulation of the glucose and lipid metabolic axes during this transition. In the oocyte stage, the metabolic state is relatively quiescent, relying on cumulus cell-supplied pyruvate for survival. Concurrently, the pentose phosphate pathway and hexosamine biosynthetic pathway are utilized to accumulate antioxidants and signaling molecules, thereby preparing the oocyte for future developmental competence. Following zygotic genome activation (ZGA), the embryo initiates metabolic reprogramming. The primary energy source shifts to glucose, with significant upregulation of glycolysis and lipid synthesis to meet the bioenergetic and biosynthetic demands of rapid proliferation and lineage specification. The interplay between glucose and lipid metabolism，through shared substrates and integrated signaling pathways, constitutes the core network that drives this reprogramming and governs cell fate decisions. This article systematically elucidates the key metabolic pathways and their interaction mechanisms. We propose that future breakthroughs will emerge from combining multi-omics analyses, isotope tracing and targeted interventions at critical nodes to systematically uncover the regulatory logic of metabolic reprogramming. Such efforts will establish a theoretical foundation for developing novel strategies to actively modulate embryonic developmental potential and enhance ART success rates.

The core characteristics of ovarian aging are the depletion of ovarian follicle reserve and the decline in oocyte quality. In recent years, disordered amino acid metabolism has been confirmed to be closely associated with the process of ovarian aging. This article provides a systematic review of the role of amino acid metabolic network in ovarian aging. It encompasses various aging-related metabolic alterations, including dysregulated branched-chain amino acid (BCAA) metabolism, increased glutamine dependency coupled with reduced metabolic efficiency, impaired one-carbon metabolism, disturbances in the arginine-nitric oxide-polyamine axis and changes in taurine levels. These metabolic changes impair follicular development, granulosa cell function and oocyte quality through multiple mechanisms. This review not only offers a new perspective for understanding the pathological mechanisms of ovarian aging but also provides a crucial theoretical foundation for developing innovative strategies—such as nutritional interventions or targeted regulation of amino acid metabolism—to delay ovarian aging and improve female fertility potential.

Objective To explore the effect of tomato derived nanovesicles (TDNVs) on the malignant biological behavior of oral squamous cell carcinoma (OSCC) and its potential molecular mechanism. Methods TDNVs in tomato fruits were extracted and purified by optimizing ultracentrifugation and sucrose density gradient centrifugation. The morphology and particle size were identified by transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA) experiments. Coomassie Brilliant Blue staining was employed to detect the TDNVs protein content. The effects of TDNVs on the proliferation, cell cycle and apoptosis abilities of WSU-HN6 and SCC-15 cells were detected by cell counting kit 8 (CCK-8) and flow cytometry, respectively. The expression of genes related to cell cycle and apoptosis was detected by Real-time PCR and Western blot experiment. Results TDNVs were successfully isolated and identified, and the average particle size of TDNVs was 167.8 nm. The particle concentration is approximately 1.3×10¹¹ particles/mL. In vitro experiments demonstrated that TDNVs could significantly inhibit the proliferation ability of OSCC cells (P<0.05), induced cell cycle arrest at the G₂/M phase and promoted cell apoptosis (P<0.05). Meanwhile, TDNVs treatment led to a decrease in the mRNA expression levels of cyclin-dependent kinase 1 (CDK1), Cyclin B1 and B-lymphoblastoma-2 gene (Bcl-2) in OSCC cells (P<0.05). The mRNA expression level of Bcl-2 associated X protein (Bax) increased (P<0.05). Conclusion TDNVs can inhibit the malignant progression of OSCC cells by inducing cell cycle arrest and promoting apoptosis.

Objective To elucidate the regulatory mechanism of xiebai san (XBS) and its combination with azithromycin (AZM) on LPS-induced acute lung injury (ALI) in juvenile rats. Methods Thirty rats were divided into the control group, the model group, the AZM group, the XBS group and the XBS combined with AZM (combined) group according to body weight by stratified random method, with 6 rats in each group. In addition to the control group, the other groups were treated with aerosol inhalation of LPS to establish the ALI model of young rats. Levels of superoxide dismutase (SOD), malondialdehyde (MDA) and catalase (CAT) in lung tissue were detected using biochemical kits. Serum interleukin (IL-6, IL-10 and IL-13) and nuclear factor-κB (NF-κB) were measured by enzyme-linked immunosorbent assay. Transcriptomic analysis was performed to identify differentially expressed genes (DEGs) in lung tissue, followed by enrichment analysis. Immunohistochemistry was used to assess cyclooxygenase-2 (COX-2) and tumor necrosis factor-α (TNF-α) expression in lung tissue. Results Compared with the control group, the activities of SOD and CAT in lung tissue of rats decreased in the model group, and the content of MDA increased (P < 0.05). Serum levels of IL-6, IL-10, IL-13 and NF-κB all increased (P < 0.05). Compared with the model group, SOD and CAT activities in lung tissue significantly increased in the AZM group and the combined group（P<0.05), while SOD activity increased and MDA content decreased in the XBS group. Serum inflammatory factors IL-6, IL-10 and IL-13 levels were significantly reduced in the AZM group, the XBS group and the combined group, with NF-κB levels also decreasing in the XBS group（P<0.05). Transcriptomic analysis revealed that XBS and its combination with AZM alleviated ALI by modulating the IL-17 signaling pathway. Immunohistochemistry indicated significantly reduced COX-2 and TNF-α expression in the AZM group, the XBS group and the combined group compared to those of the model group. Conclusion XBS and its combination with azithromycin may ameliorate ALI in juvenile rats by regulating the IL-17 signaling pathway, oxidative stress, inflammatory responses and lung gene expression.

Objective To discuss the effect of koumine (KM) on cartilage injury in rats with knee osteoarthritis (KOA) by regulating the adenosine monophosphate activated protein kinase (AMPK)/Nod-like receptor protein 3 (NLRP3) pathway. Methods The KOA rat model was constructed and separated into the KOA group, the low and high dose KM (L, H-KM) groups, the positive drug (celecoxib) group and the H-KM+AMPK inhibitor Compound C group, with 12 rats per group. Another 12 rats were used as the control (CK) group. The knee joint width, joint swelling and gait score were measured. ELISA was used to detect the levels of IL-18, IL-1β and TNF-α. HE staining, Safranin O-Fast Green staining and transmission electron microscopy were used to observe the pathological changes, structural changes and microstructure of cartilage tissue. In addition, Western blot assay was used to detect the expression of AMPK/NLRP3 pathway related proteins. Results The KOA group showed obvious pathological changes: rough tissue surface, disordered cell hypertrophy and broken tidal lines. The lightening of the red color in Safran-solid green staining indicated the loss of proteoglycans. The cells experienced particle shedding, swelling and rupture of their contents. The KOA group showed increased knee joint width, joint swelling degree, gait score, IL-18, IL-1β, TNF-α levels and NLRP3 protein expression, while decreased p-AMPK/AMPK ratio than those of the CK group (P<0.05). The L-KM group and the H-KM group and the celecoxib group showed decreased knee joint width, joint swelling degree, gait score, IL-18, IL-1β, TNF-α levels, NLRP3 protein expression and pathological damage, while increased p-AMPK/AMPK ratio than those of the KOA group (P<0.05). The H-KM+Compound C group showed increased knee joint width, joint swelling degree, gait score, IL-18, IL-1β, TNF-α levels, NLRP3 protein expression and pathological damage, while decreased p-AMPK/AMPK ratio than those of the CK group (P<0.05). Conclusion KM may alleviate cartilage injury in KOA rats by activating the AMPK/NLRP3 pathway.

Objective To investigate the therapeutic efficacy of intrauterine perfusion with sodium hyaluronate hydrogel loaded with luteolin in a rat model of intrauterine adhesion (IUA). Methods Fifty specific pathogen free (SPF)-level SD rats were randomly assigned to five experimental groups: the normal control group (group A), the IUA model group (group B), the sodium hyaluronate hydrogel treatment IUA group (group C), the luteolin solution treatment IUA group (group D) and the sodium hyaluronate hydrogel loaded with luteolin treatment IUA group (group E), with 10 rats in each group. Except for the group A, which only received gas anesthesia, IUA model was established in all other groups using a 95% ethanol injection method. One week after modeling, rats in the groups B, C, D and E received intrauterine injection of normal saline, sodium hyaluronate hydrogel, 10 g/L luteoloside solution and sodium hyaluronate hydrogel loaded with 10 g/L luteoloside, respectively. Following a 7-day intervention period, protein expression levels of matrix metalloproteinase-9 (MMP-9), transforming growth factor-β1 (TGF-β1), Vimentin, collagen type Ⅴ alpha 2 chain (COL5A2) and collagen type I alpha 1 chain (COL1A1) in endometrial tissue were assessed by Western blot analysis. Serum concentrations of interleukin-6 (IL-6) and IL-8 were measured using enzyme-linked immunosorbent assays (ELISA). Two weeks post-intervention, the number of gestational sacs was recorded following pregnancy induction. Results Compared with the group A, the expression levels of TGF-β1, vimentin, COL5A2, COL1A1, IL-6 and IL-8 were increased, MMP-9 protein expression was decreased and the number of gestational sacs was reduced in the groups B, C, D and E (P < 0.05). Compared with the group B, expression levels of TGF-β1, vimentin, COL5A2, COL1A1, IL-6 and IL-8 decreased, MMP-9 protein expression increased and number of gestational sacs increased in the groups C, D and E (P < 0.05). These changes were more pronounced in the group E. Conclusion Intrauterine perfusion of sodium hyaluronate hydrogel loaded with luteoloside effectively alleviates intrauterine adhesions, suppresses inflammatory responses and enhances reproductive outcomes in the rat IUA model, demonstrating superior therapeutic efficacy compared to monotherapy approaches.

Objective To evaluate the value of peripheral perfusion index (PPI) combined with plasma volume (PV) in the 28-day prognosis of patients with septic shock. Methods A total of 150 septic shock patients were divided into two groups based on their 28-day survival status: the death group (n=52) and the survival group (n=98). The general information, laboratory test results within 6 hours of admission, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, PPI and PV were compared between the two groups. The Cox proportional hazards regression model was used to analyze the influencing factors of patient mortality, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of PPI and PV for patient mortality. The 28-day mortality rates of patients with PPI and PV at different levels were compared using the Kaplan-Meier curve. Results Compared with the survival group, patients in the death group were significantly older, with increased SOFA score, APACHE Ⅱ scores, hematocrit (HCT), and decreased PPI and PV values (all P<0.05). Cox proportional hazards regression analysis revealed that older age (HR=1.033, 95%CI: 1.011-1.055), elevated SOFA score (HR=1.186, 95%CI: 1.050-1.339) and increased APACHE Ⅱ score (HR=1.137, 95%CI:1.079-1.197) were independent risk factors for 28-day mortality in patients with septic shock. In contrast, PPI (HR=0.136, 95%CI: 0.062-0.296) and PV (HR=0.904, 95%CI: 0.858-0.951) served as independent protective factors against 28-day mortality (all P<0.05). Based on optimal cut-off values, patients were stratified into the high PPI group (≥1.60, n=78), the low PPI group (<1.60, n=72), the high PV group (≥38.5 mL/kg, n=69) and the low PV group (<38.5 mL/kg, n=81). Kaplan-Meier survival analysis demonstrated significantly higher cumulative 28-day survival rates in the high PPI group and the high PV group compared with their respective low-value groups (all P<0.05). ROC curve analysis showed that the combined use of PPI and PV yielded an AUC of 0.953 (95%CI: 0.923-0.983) for predicting 28-day mortality in septic shock patients, with a sensitivity of 88.46% and specificity of 88.78% (all P<0.05). Conclusion The combination of PPI and PV has significant value in predicting the prognosis of patients with septic shock and can provide strong evidence for clinical treatment decision.

Objective To evaluate the clinical value of lung ultrasound score (LUS), serum pulmonary surfactant-associated protein A (SP-A) and interleukin-6 (IL-6) levels in the condition and prognosis of neonatal respiratory distress syndrome (NRDS). Methods The clinical data of 205 neonates with NRDS were retrospectively analyzed. Based on the oxygenation index (OI) at admission, patients were divided into the severe group (n=55), the moderate group (n=78) and the mild group (n=72). According to the clinical outcomes during follow-up, they were categorized into the good prognosis group (n=143) and the poor prognosis group (n=62). Differences in LUS, serum SP-A and IL-6 levels were compared between the groups. Pearson correlation analysis was used to assess the relationship between these indicators and OI. Multivariate Logistic regression analysis was performed to identify independent risk factors for poor prognosis. The predictive efficacy of each indicator was evaluated using receiver operating characteristic (ROC) curve analysis. Results Compared with the mild group, the LUS scores, SP-A and IL-6 levels were all increased in the moderate group and the severe group, and all indicators were significantly higher in the severe group than those in the moderate group (P<0.05). The LUS score, SP-A and IL-6 levels were positively correlated with OI in children with NRDS (r was 0.572, 0.613 and 0.695 respectively, P<0.05). Compared with the good prognosis group, children with NRDS in the poor prognosis group had a lower gestational age, higher OI, white blood cell count, LUS score, SP-A and IL-6 levels (P<0.05). Multivariate Logistic regression analysis showed that high OI (OR=3.374, 95%CI: 2.063-5.518), high LUS score (OR=3.068, 95%CI: 1.533-6.140), high serum SP-A (OR=2.356, 95%CI: 1.327-4.184) and high IL-6 level (OR=1.929, 95%CI: 1.348-2.761) were independent risk factors for poor prognosis in children with NRDS (P<0.05). ROC curve analysis showed that the areas under the curve (95%CI) for predicting poor prognosis using IL-6, LUS, SP-A and OI individually and in combination were 0.721 (0.654-0.781), 0.769 (0.705-0.825), 0.698 (0.630-0.760), 0.785 (0.722-0.839) and 0.896 (0.846-0.934), respectively. The combined model demonstrated the highest predictive efficacy. Conclusion LUS score, serum SP-A and IL-6 levels are positively correlated with the severity of NRDS. A predictive model combining these indicators with OI can effectively predict the prognosis of neonates with NRDS.

Objective To study the safety and efficacy of ultrasound-guided superior laryngeal nerve block (SLNB) in endotracheal intubation with preserved spontaneous breathing. Methods Sixty patients requiring endotracheal intubation with preserved spontaneous breathing were randomly divided into the ultrasound-guided SLNB group (group L) and the supraglottic airway surface anesthesia group (group C), with 30 cases in each group. Patients in the group L underwent bilateral SLNB under ultrasound guidance with 2% lidocaine. In the group C, 2% lidocaine was used successively for surface anesthesia of the pharynx, palatine tonsils, base of the tongue, epiglottis, piriform crypts and glottis. Both groups underwent surface anesthesia of the trachea through cricothyroid membrane puncture, and 1% tetracaine was selected as the drug. The main observation indicators included the nausea and choking cough scores when the laryngoscope was inserted to the root of the epiglottis (T₂), immediately after the tracheal tube was inserted into the glottis (T₃) and when the tube sleeve was inflated after the tracheal tube entered the trachea (T₄). Secondary observation indicators included changes in mean arterial pressure (MAP), heart rate (HR), vocal cord movement, 3 min after the patient entered the room (T₀), before tracheal intubation (T₁) and after tracheal intubation (T₅). The incidence rates of sore throat score, postoperative nausea and vomiting, hoarseness, hematoma at the puncture site, infection and nerve injury, as well as patient satisfaction were also recorded. Results Compared with the group C, the nausea and choking cough scores were decreased at T₂ and T₃ in the group L (P < 0.05), while there were no statistically significant differences in nausea and choking cough scores between the two groups at T₄ (P > 0.05). There were no significant differences in MAP and HR before and after tracheal intubation between the two groups (P > 0.05). Compared with the group C, the vocal cord activity was more conducive to the operation of tracheal intubation in the group L (P < 0.01). At 24 hours after the operation, the postoperative sore throat score was decreased in patients of the group L (P < 0.01), and the satisfaction score increased (P < 0.05). In the group C, there was one case of postoperative nausea and vomiting. In the group L, there were 2 cases of postoperative nausea and vomiting, 1 case of postoperative hoarseness. There was no significant difference in the incidence of adverse reactions between the two groups (3.3% vs. 10.0%, χ²=1.071, P>0.05). Conclusion The application of SLNB under ultrasound guidance can enhance the safety and effectiveness of patients during the process of endotracheal intubation with preserved spontaneous breathing, relieve nausea, choking cough and postoperative sore throat.

Objective To investigate the expression levels of plasma marinobufagenin (MBG) and type Ⅰ collagen α1 chain (COL1A1) in patients with chronic heart failure (CHF) and their correlation with prognosis. Methods A total of 126 patients with CHF (CHF group) and 63 healthy volunteers (control group) were enrolled. According to the New York Heart Association (NYHA) functional classification, CHF patients were divided into the class Ⅱ (n=48), the class Ⅲ (n=44), and the class Ⅳ (n=34) groups. Based on the 6-month follow-up outcomes, patients were classified into the poor prognosis and the good prognosis groups. Plasma MBG and COL1A1 levels were measured, and their relationships with NYHA classification and prognosis were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate predictive efficacy. Results Plasma MBG and COL1A1 levels were significantly higher in the CHF group than those in the control group (P<0.05). Among CHF patients, plasma MBG and COL1A1 levels increased progressively from NYHA class Ⅱ to Ⅳ (P<0.05) and were positively correlated with NYHA classification (P<0.05). During the 6-month follow-up, the incidence of poor prognosis in CHF patients was 31.75% (40/126). Multivariate logistic regression showed that NYHA class Ⅳ (OR=4.007, 95%CI: 1.858-8.643), N-terminal pro-B-type natriuretic peptide (OR=1.001, 95%CI: 1.000-1.001), MBG (OR=1.020, 95%CI: 1.010-1.030), and COL1A1 (OR=1.037, 95%CI: 1.017-1.056) were independent risk factors for poor prognosis (P<0.05). The area under the ROC curve (AUC) for the combined prediction of MBG and COL1A1 was 0.880 (95%CI: 0.810-0.931), which was superior to MBG (0.786, 95%CI: 0.704-0.854) or COL1A1 (0.797, 95%CI: 0.716-0.863) alone (P<0.05). Conclusion Elevated plasma MBG and COL1A1 levels are associated with impaired cardiac function and poor prognosis in CHF patients, and their combined measurement provides higher predictive value for adverse outcomes.

Objective To establish and validate an early risk warning model for the potential high-risk population of chronic obstructive pulmonary disease (COPD) progressing to type II respiratory failure. Methods Stratified random sampling method was used to divide 297 COPD patients who met the inclusion criteria after acute hospitalization into stable stage into the modeling set (n=208) and the validation set (n=89) according to the ratio of 7∶3. The patients in the modeling set were divided into the progressive group (n=81) and the non-progressive group (n=127) according to whether the re-acute exacerbation progressed to type II respiratory failure. The clinical data of the progressive group and the non-progressive group were compared. The random forest was used to preliminarily screen the predictive feature variables. Least absolute shrinkage and selection operator（LASSO） regression was used to further compress and screen the important predictive feature variables, and the nomogram early warning recognition model was constructed and verified. Results There were no significant differences in age, gender, body mass index (BMI), past history, stable treatment plan, course of disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) lung function classification, number of acute exacerbations in the past year, sarcopenia and laboratory examination indexes [white blood cells, hemoglobin, platelets, neutrophils, eosinophils（EOS), albumin and pulmonary surfactant protein-D（SP-D)] between the modeling set and the validation set. The age, GOLD lung function classification, proportion of patients with acute exacerbation ≥ 2 times in the past year, proportion of patients with sarcopenia, EOS and SP-D were higher in the progressive group than those in the non-progressive group, the course of disease was longer than that of the non-progressive group, and the albumin level was lower than that in the non-progressive group (P<0.05). Based on this random forest, the top six important characteristic variables were course of disease, GOLD lung function classification, the number of acute exacerbations in the past year, sarcopenia, EOS and SP-D. After further compression by LASSO, GOLD lung function classification, the number of acute exacerbations in the past year, sarcopenia, EOS and SP-D were finally determined to be important predictors of COPD progression to type Ⅱ respiratory failure (P<0.05). Based on this, the consistency index（C-index）of the early warning identification model was 0.904. Receiver operating characteristic (ROC) curve showed that the area under the curve of the model was 0.904（95%CI: 0.860-0.948) and 0.924（95%CI: 0.861-0.986） in the modeling set and the validation set, respectively. The results of calibration curve and decision curve showed that the model had good calibration and clinical applicability. Conclusion The nomogram early warning recognition model based on predictors has good predictive performance and clinical applicability.

Objective To investigate the effects of Danggui Shaoyao San combined with Bacillus subtilis dual live bacteria enteric coated capsules on the body shape, biochemical and imaging indicators of patients with non-alcoholic fatty liver disease (NAFLD). Methods A total of 118 NAFLD patients were selected as the research subjects and randomly divided into the control group and the observation group using a random number table method, with 59 cases in each group. The control group was treated with Bacillus subtilis dual active bacteria enteric coated capsules, while the observation group was treated with Danggui Shaoyao San on this basis. The body morphology indicators such as body fat percentage and body mass index (BMI), and serum levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured between the two groups before treatment, after 2 months of treatment and at 6-month of follow-up. Enzyme-linked immunosorbent assay (ELISA) was used to determine serum concentrations of tumor necrosis factor-α (TNF-α), adiponectin (APN) and interleukin-6 (IL-6). Hepatic steatosis was graded using color Doppler ultrasound. Adverse events during treatment were recorded. Results Compared with baseline, both groups showed significant reduction in body fat percentage, BMI, TG, TC, LDL-C, IL-6, TNF-α, AST and ALT levels, along with increase in HDL-C and APN levels and improvements in fatty liver classification at 2 months of treatment and 6 months of follow up (all P<0.05). At both time points, the improvements were significantly greater in the observation group than those in the control group (P<0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups. Conclusion Danggui Shaoyao San combined with Bacillus subtilis dual active bacteria enteric coated capsules can effectively improve body shape, blood lipid levels and fatty liver grading of NAFLD patients, regulate liver function, and have high safety.

Objective To investigate the effect of evodia delavonium decoction combined with dolasetron mesylate on the efficacy in patients of chemotherapy-induced vomiting. Methods A total of 116 patients with chemotherapy-induced vomiting admitted to our hospital from June 2023 to January 2025 were enrolled. Patients were divided into two groups with 58 cases in each group. The control group was treated with dolasetron mesylate for antiemetic, and the observation group was supplemented with evodia decoction on the basis of it. The treatment effects including complete remission rate and complete control rate of patients in the acute stage, delayed period and whole course of treatment were counted, and the degree of vomiting after treatment was evaluated. Serotonin (5-HT), immune function indicators, and liver and kidney function indicators before and after treatment were evaluated. Results Compared with the control group, the observation group showed an increased complete relief rate and complete control rate during the delayed phase and throughout the treatment (P<0.05). There was significant difference in the degree of vomiting between the two groups (P<0.05). Compared with the control group, 5-HT levels decreased in the delayed phase of the observation group (P<0.05). Compared with the control group, the levels of immunoglobulin A, immunoglobulin M and immunoglobulin G increased after treatment in the observation group (P<0.05). There were no significant differences in blood urea nitrogen, creatinine, alanine aminotransferase and aspartate aminotransferase before and after treatment between both groups (P>0.05), and there were no significant differences in these indicators between the two groups (P>0.05). Conclusion Wuzhuyu decoction combined with dexamethasone can effectively relieve chemotherapy-induced vomiting, reduce the severity of vomiting and 5-HT levels, improve humoral immunity, and is safe and effective.

Objective To compare the long-term efficacy and safety of infliximab (IFX) and ustekinumab (UST) in the treatment of moderate to severe Crohn's disease (CD). Methods Clinical data of 126 patients with moderate to severe CD treated with either IFX or UST were selected, including 84 patients in the IFX group and 42 patients in the UST group. After 54 weeks of treatment, clinical remission rates, clinical response rates, endoscopic remission rates, changes in Crohn's Disease Activity Index (CDAI), Harvey-Bradshaw Index (HBI), Simplified Endoscopic Scoring of Crohn's Disease (SES-CD), laboratory markers, inflammatory bowel disease quality of life (IBDQ) scores, FACIT-F scores and adverse event rates were compared between the two groups. Results There were no significant differences in patient age, gender, body mass index, disease duration, smoking history, previous surgical history, family history or disease location between the two groups of patients (P>0.05). After 54 weeks of treatment, the clinical remission rates in the IFX group and the UST group were 73.8% and 59.5%, respectively, the clinical response rates were 89.3% and 83.3%, and the endoscopic remission rates were 57.1% and 47.6%. There were no significant differences between the groups (P>0.05). After treatment, both groups showed a significant decrease in CDAI, HBI and SES-CD scores (P<0.05), with no significant differences between the groups. Both groups showed a decrease in C-reactive protein and fecal calprotectin levels, and an increase in albumin and hemoglobin levels after treatment in the two groups of patients (P<0.05). There were no significant differences in IBDQ and FACIT-F scores between the two groups of patients, and the incidence of adverse events was similar (P>0.05). Conclusion Both IFX and UST can effectively improve the clinical symptoms and endoscopic inflammation in patients with moderate to severe CD, with good safety. Both treatments can also improve the' quality of life of patients.

Objective To analyze the trends in incidence, prevalence and Disability-Adjusted Life Years (DALYs) associated with polycystic ovary syndrome (PCOS) in women globally and in China from 1990 to 2021, as well as to predict the changes from 2022 to 2031. Methods The data is sourced from the Global Burden of Disease (GBD 2021) database, which provided information on the burden of PCOS globally and in China from 1990 to 2021. Joinpoint regression analysis was employed to compute the annual percentage changes along with the 95% confidence intervals (95%CI) for age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR) and age-standardized DALYs rate (ASDR) to assess the trends over time. The burden of PCOS in China and globally from 2022 to 2031 was predicted using the Nordpred package in R language. Results In 2021, the ASIR of PCOS in China was 58.61 (95%UI: 41.19-82.36) per 100 000, while the ASPR was 1544.17 (95%UI: 1081.33-2169.82) per 100 000, and the ASDR was 13.34 (95%UI: 5.88-27.55) per 100 000, which is slightly below the global average. From 1990 to 2021, the annual percentage changes in ASIR, ASPR and ASDR for PCOS in women globally were 0.80% (95%CI: 0.79%-0.81%), 0.81% (95%CI: 0.80%-0.82%) and 0.79% (95%CI: 0.78%-0.80%), respectively. In contrast, these corresponding annual percentage changes in China were higher, at 2.01% (95%CI: 1.99%-2.04%), 2.01% (95%CI: 1.99%-2.03%) and 2.04% (95%CI: 2.02%-2.06%). It is predicted that by 2031, the burden of PCOS in women globally and in China will continue to rise. Conclusion This study indicates that the burden of PCOS in China between 1990 and 2021 is slightly lower than the global average, but the growth rate is faster. It is anticipated that from 2022 to 2031, the incidence, prevalence and DALYs rates of PCOS in China will continue to rise.

Extremely low birth weight infants (ELBWI) are at extremely high anesthetic risk due to immature organ development and immune dysfunction, which may lead to various severe perioperative complications. The article presents clinical data of a case of systemic multiple organ hypoplasia with severe infection underwent partial resection and anastomosis of the small intestine in an extremely low birth weight infant (ELBWI). Through comprehensive preoperative assessment, refined medication, multidisciplinary team collaboration, and individualized planning during the perioperative period, the child achieved a good postoperative outcome. The article discusses the impact of sevoflurane inhalation anesthesia combined with caudal block on abdominal operation, intraoperative analgesia, hemodynamic changes in the child, occurrence of adverse reactions and long-term prognosis in ELBWI, providing a reference for anesthesiologists in the perioperative management of ELBWI.

Zirconia ceramics are considered ideal materials for dental restorations. However, at room temperature, their monoclinic crystal phase structure is prone to sintering cracks and brittleness problems. Additionally, zirconia material itself lacks biological properties such as antibacterial and anti-inflammatory effects, which limits their its clinical application. Due to their distinctive physicochemical characteristics, rare earth elements are increasingly utilized as stabilizers and multifunctional additives in advanced zirconia-based studies. This article reviews the current applications of rare earth elements in zirconia-based dental restorative materials, examines their potential value in clinical practice and explores future development trends, with the aim of providing insights for the innovation of dental restorative materials.