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Background The relationship between triglyceride-glucose index (TyG index) and the prevalence and prognosis of cardiovascular disease has been confirmed by former studies. However, it remains uncertain whether TyG index has a prognostic impact in patients with type 2 diabetes mellitus (T2DM) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). Methods The study retrospectively enrolled 798 patients (mean age: 60.9 ± 8.3 years; 68.3% men) with T2DM and NSTE-ACS who underwent PCI at Beijing Anzhen Hospital from January to December 2015. TyG index was calculated as previously reported: ln [fasting TGs (mg/dL) * FBG (mg/dL)/2]. The primary endpoint was a composite of adverse events as follows: all-cause death, non-fatal myocardial infarction (MI) and ischemia-driven revascularization. Results TyG index was significantly higher in patients with a primary endpoint event compared with those without. Multivariate Cox proportional hazards analysis showed that 1-unit increase of TyG index was independently associated with higher risk of primary endpoint, independent of other risk factors [hazard ratio (HR) 3.208 per 1-unit increase, 95% confidence interval (CI) 2.400–4.289, P < 0.001]. The addition of TyG index to a baseline risk model had an incremental effect on the predictive value for adverse prognosis [AUC: baseline risk model, 0.800 vs. baseline risk model + TyG index, 0.856, P for comparison < 0.001; category-free net reclassification improvement (NRI) 0.346, P < 0.001; integrated discrimination improvement (IDI) 0.087, P < 0.001]. Conclusions Increased TyG index is a significant predictor of adverse prognosis in patients with T2DM and NSTE-ACS undergoing PCI. Further studies need to be performed to determine whether interventions for TyG index have a positive impact on improving clinical prognosis.

Ship-source pollution is one of the important contributors to marine environment pollution. Because the legal status of the Arctic shipping routes is not clear, there is a considerable degree of dispute in the application of the rules on the prevention and control of ship-source pollution. The increased melting of sea ice undermines the legal legitimacy of the “ice-covered areas” clause under the United Nations Convention on the Law of the Sea. The conflict between the application of the Polar Code and “ice-covered areas” will also reach an initial conclusion in the context of melting sea ice. However, the inadequacy of ship-source pollution rules in the Polar Code hampers its application, which has led to a negative impact on the more active role in the governance of pollution from Arctic shipping. For replying to the Challenges in the prevention of ship-source pollution in Arctic shipping routes, the relevant rules of the Polar Code need to be further improved, while a more binding HFO ban according to ship types needs to be applied. Therefore, a more important role in the future Arctic governance mechanism will be played by the enhanced enforcement of the Polar Code, meanwhile, the target for uniform international regulation of preventing and controlling ship-source pollution in Arctic shipping routes should be achieved.

Emerging reconfigurable metasurfaces offer various possibilities for programmatically manipulating electromagnetic waves across spatial, spectral, and temporal domains, showcasing great potential for enhancing terahertz applications. However, they are hindered by limited tunability, particularly evident in relatively small phase tuning over 270°, due to the design constraints with time‐intensive forward design methodologies. Here, a multi‐bit programmable metasurface is demonstrated capable of terahertz beam steering facilitated by a developed physics‐informed inverse design (PIID) approach. Through integrating a modified coupled mode theory (MCMT) into residual neural networks, the PIID algorithm not only significantly increases the design accuracy compared to conventional neural networks but also elucidates the intricate physical relations between the geometry and the modes. Without decreasing the reflection intensity, the method achieves the enhanced phase tuning as large as 300°. Additionally, the inverse‐designed programmable beam steering metasurface is experimentally validated, which is adaptable across 1‐bit, 2‐bit, and tri‐state coding schemes, yielding a deflection angle up to 68° and broadened steering coverage. The demonstration provides a promising pathway for rapidly exploring advanced metasurface devices, with potentially great impact on communication and imaging technologies. Emerging reconfigurable metasurfaces can manipulate electromagnetic waves for photonic applications but face tunability limitations at terahertz frequency and above. A multi‐bit programmable metasurface, developed using a physics‐informed inverse design approach, significantly enhances terahertz beam steering accuracy. It supports adaptable coding schemes, achieving deflection angles up to 68°, offering a promising pathway for advanced metasurfaces in communication and imaging applications.

Background Recent research suggests that periodontitis can increase the risk of chronic obstructive pulmonary disease (COPD). In this study, we performed two-sample Mendelian randomization (MR) and investigated the causal effect of periodontitis (PD) on the genetic prediction of COPD. The study aimed to estimate how exposures affected outcomes. Methods Published data from the Gene-Lifestyle Interaction in the Dental Endpoints (GLIDE) Consortium’s genome-wide association studies (GWAS) for periodontitis (17,353 cases and 28,210 controls) and COPD (16,488 cases and 169,688 controls) from European ancestry were utilized. This study employed a two-sample MR analysis approach and applied several complementary methods, including weighted median, inverse variance weighted (IVW), and MR-Egger regression. Multivariable Mendelian randomization (MVMR) analysis was further conducted to mitigate the influence of smoking on COPD. Results We chose five single-nucleotide polymorphisms (SNPs) as instrumental variables for periodontitis. A strong genetically predicted causal link between periodontitis and COPD, that is, periodontitis as an independent risk factor for COPD was detected. PD (OR = 1.102951, 95% CI: 1.005–1.211, p  = 0.039) MR-Egger regression and weighted median analysis results were coincident with those of the IVW method. According to the sensitivity analysis, horizontal pleiotropy’s effect on causal estimations seemed unlikely. However, reverse MR analysis revealed no significant genetic causal association between COPD and periodontitis. IVW (OR = 1.048 > 1, 95%CI: 0.973–1.128, p  = 0.2082) MR Egger (OR = 0.826, 95%CI:0.658–1.037, p  = 0.1104) and weighted median (OR = 1.043, 95%CI: 0.941–1.156, p  = 0.4239). The results of multivariable Mendelian randomization (MVMR) analysis, after adjusting for the confounding effect of smoking, suggest a potential causal relationship between periodontitis and COPD ( P  = 0.035). Conclusion In this study, periodontitis was found to be independent of COPD and a significant risk factor, providing new insights into periodontitis-mediated mechanisms underlying COPD development.

Evidences suggested that gamma-glutamyltransferase (GGT) to high-density lipoprotein cholesterol (HDL-C) ratio (GTHR) was a reliable surrogate indicator for fatty liver disease, diabetes, metabolic syndrome. However, the relationship between GTHR and the presence of arterial stiffness remains unclear in healthy population. In the present study, we aimed to explore the association between GTHR and arterial stiffness (AS) in a health check-up population from Japan. This study is a secondary analysis from a health check-up program carried out at Murakami Memorial Hospital, Gifu, Japan between March 2004 and December 2012. A total of 912 individuals were included in this study. Patients were divided into three groups according to the tertiles of LogGTHR. The univariate linear regression model and the multivariate models were performed to explore the association between between LogGTHR and baPWV. Smoothed curve fit analysis was used to explore the linear or the nonlinear relationship between LogGTHR and baPWV. The modification and interaction of subgroup were inspected by the likelihood ration test. After adjusting for confounders, there is a nonlinear relationship between LogGTHR and baPWV (β=30.08, 95%CI: -33.12 to 93.29, =0.351). The inflection point was 1.43. When K<1.43 (80.37% of the participants), the relationship was positively correlated (β=165.15, 95%CI: 62.72 to 267.58, =0.0016), while when ≥1.43, there was a negative association between LogGTHR and baPWV (β= -106.23, 95%CI: -209.25 to -3.21, =0.0436). Subgroup analysis suggested that LogGTHR was not associated with baPWV in any of these subgroups. In this cross-sectional study, there was a nonlinear positive association between LogGTHR and AS. LogGTHR was positively related with baPWV when less than 1.43, while this association was negative when LogGTHR was >1.43.

The incidence of stomach diseases is very high, which has a significant impact on human health. Damaged gastric mucosa is more vulnerable to injury, leading to bleeding and perforation, which eventually aggravates the primary disease. Therefore, the protection of gastric mucosa is crucial. However, existing drugs that protect gastric mucosa can cause nonnegligible side effects, such as hepatic inflammation, nephritis, hypoacidity, impotence, osteoporotic bone fracture, and hypergastrinemia. Autophagy, as a major intracellular lysosome-dependent degradation process, plays a key role in maintaining intracellular homeostasis and resisting environmental pressure, which may be a potential therapeutic target for protecting gastric mucosa. Recent studies have demonstrated that autophagy played a dual role when gastric mucosa exposed to biological and chemical factors. More indepth studies are needed on the protective effect of autophagy in gastric mucosa. In this review, we focus on the mechanisms and the dual role of various biological and chemical factors regulating autophagy, such as Helicobacter pylori, virus, and nonsteroidal anti-inflammatory drugs. And we summarize the pathophysiological properties and pharmacological strategies for the protection of gastric mucosa through autophagy.

Background It is uncertain whether estimated remnant-like particle cholesterol (RLP-C) could predict residual risk in patients with different glycometabolic status. This study aimed to evaluate the relationship between estimated RLP-C and adverse prognosis in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) treated with percutaneous coronary intervention (PCI) and to identify the potential impact of glycometabolism on the predictive value of estimated RLP-C. Methods The study assessed 2419 participants with NSTE-ACS undergoing PCI at Beijing Anzhen Hospital from January to December 2015. Estimated RLP-C was calculated as follows: total cholesterol (TC) minus low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The adverse events included all-cause death, non-fatal myocardial infarction (MI), and ischemia-driven revascularization. Results Estimated RLP-C was prominently associated with adverse prognosis in the total population [hazard ratio (HR) 1.291 per 1-SD increase, 95% confidence interval (CI) 1.119–1.490, P  <  0.001], independent of confounding risk factors. However, subgroup analysis showed that increasing estimated RLP-C was related to a higher risk of adverse events in the diabetic population only [HR 1.385 per 1-SD increase, 95% CI 1.183–1.620, P  <  0.001]. Estimated RLP-C failed to be a significant determinant of adverse prognosis in non-diabetic and pre-diabetic subgroups. The addition of estimated RLP-C to a baseline model including traditional risk factors enhanced the predictive performance both in total and diabetic populations. Conclusions High estimated RLP-C level is a significant predictor for recurrent adverse events in patients with diabetes and NSTE-ACS treated with PCI.

This systematic review and meta-analysis evaluated whether multimodal intervention bundles improve recovery after cesarean section compared with routine care. Following PRISMA 2020, we searched PubMed, Embase, Scopus, Web of Science, and major Chinese databases (CNKI, Wanfang, VIP) from inception to July 2025 without language restrictions. Eligible randomized controlled trials enrolled postpartum women undergoing cesarean section and implemented bundles comprising ≥2 distinct domains (e.g., opioid-sparing analgesia, early mobilization, early oral intake/nutrition or breastfeeding support, structured nursing, psychological education). The primary endpoint was pain intensity at 24 h (VAS); secondary endpoints included pain at other time points, analgesic consumption, time to first ambulation and first flatus, adverse events, length of stay, breastfeeding initiation/time, and maternal psychological recovery. Relative risks were pooled for dichotomous outcomes and mean (or standardized mean) differences for continuous outcomes, using random effects when heterogeneity was substantial. Twelve RCTs (  = 1,497), all conducted in China, met inclusion. Multimodal care reduced 24 h pain versus routine care (MD - 0.96 on a 0-10 VAS; 95% CI - 1.28 to -0.64; I = 97%), shortened time to first ambulation (MD - 4.58 h; 95% CI - 6.32 to -2.84; I = 95%) and to first flatus (MD - 2.28 h; 95% CI - 2.57 to -1.98; I = 97%), and lowered overall adverse events (RR 0.28; 95% CI 0.19-0.41; I = 0%). No significant difference was observed for time to first breastfeeding (MD 1.39 h; 95% CI - 3.86 to 6.64; I = 99%;  = 0.60). Risk of bias was generally moderate to high owing to limited blinding; Egger's test for the primary outcome did not suggest publication bias. Collectively, the current evidence suggests that multimodal, ERAS-oriented care pathways may facilitate safer and more rapid early recovery following cesarean section, particularly by enhancing analgesic efficacy, mobilization, and gastrointestinal function. Nevertheless, the marked heterogeneity in bundle composition, implementation intensity, and outcome definitions, together with the single-country evidence base and moderate risk of bias, substantially limits the certainty and generalizability of these findings.

Exposure to microgravity can adversely affect the fitness of astronauts. The integrity of the skin plays a crucial role in protecting against mechanical forces and infections, fluid imbalance, and thermal dysregulation. In brief, the skin wound may cause unknown challenges to the implementation of space missions. Wound healing is a physiological process that relies on the synergistic action of inflammatory cells, extracellular matrix (ECM), and various growth factors to maintain the integrity of skin after trauma. Fibroblasts are present almost throughout the entire process of wound repair, especially in the scar formation at the endpoint of wound healing. However, there is limited knowledge about the extent to which fibroblasts are affected by the lack of gravity during wound healing. In this study, we utilized the rotary cell culture system, a ground‐based facility that mimics the weightless condition, to study the alterations of L929 fibroblast cells under simulated microgravity (SMG). Our results demonstrated that the SM condition exerted negative influences on the proliferation and ECM formation of the L929 fibroblast. Whereas, the apoptosis of fibroblast was significantly upregulated upon exposure to SMG conditions. Moreover, the transforming growth factor‐β1/Smad3 (TGF‐β1/smad3) signaling pathway of L929 fibroblast related to wound repair was also altered significantly under a weightless environment. Overall, our study provided evidence that fibroblasts are strongly sensitive to SMG and elucidated the potential value of the TGF‐β1/Smad3 signaling pathway modulating wound healing in the future practice of space medicine.

Simulated microgravity can significantly affect various cell types and multiple systems of the human body, such as cardiovascular system, skeletal muscle system, and immune system, and is known to cause anemia and loss of electrolyte and fluids. Epidermal stem cells (EpSCs) were cultured in a rotary cell culture system (RCCS) bioreactor to simulate microgravity. The metabolites of EpSCs were identified by liquid chromatography-mass spectrometry (LC-MS). Compared with normal gravity (NG) group, a total of 57 different metabolites of EpSCs were identified (P<0.05, VIP > 1), including lipids and lipid-like molecules (51 molecules), amino acids (5 molecules), nucleosides, nucleotides, and analogues (1 molecule). According to the partial least squares discriminant analysis (PLS-DA) score plot, a VIP > 1 and < 0.05 were obtained for the 57 different metabolites, of which 23 molecules were significantly downregulated and 34 were significantly upregulated in simulated microgravity (SMG) group. These results showed that SMG has a significant impact on different pathways, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis indicated that multiple pathways were involved, mainly the amino acid metabolism pathway, lipid metabolism pathway, membrane transport pathway, and cell growth and death pathways. Thus, the metabolic profile of EpSCs was changed under SMG. Exploring the metabolic profile of EpSCs would be helpful to further understand the growth characteristics of EpSCs under SMG, which will provide a new approach to explore the metabolomics mechanism of stress injury and repair trauma under SMG.