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This paper introduces a novel ray-tracing methodology for various gradient-index materials, particularly plasmas. The proposed approach utilizes adaptive-step Runge–Kutta integration to compute ray trajectories while incorporating an innovative rasterization step for ray energy deposition. By removing the requirement for rays to terminate at cell interfaces – a limitation inherent in earlier cell-confined approaches – the numerical formulation of ray motion becomes independent of specific domain geometries. This facilitates a unified and concise tracing method compatible with all commonly used curvilinear coordinate systems in laser–plasma simulations, which were previously unsupported or prohibitively complex under cell-confined frameworks. Numerical experiments demonstrate the algorithm’s stability and versatility in capturing diverse ray physics across reduced-dimensional planar, cylindrical and spherical coordinate systems. We anticipate that the rasterization-based approach will pave the way for the development of a generalized ray-tracing toolkit applicable to a broad range of fluid simulations and synthetic optical diagnostics.
Hospital-acquired pneumonia (HAP) represents one of the most common nosocomial infections in intensive care units (ICUs), accounting for 25% of all hospital-acquired infections. While oral care is recommended as a preventive measure, the relationship between standardized oral care practices and HAP incidence remains incompletely characterized.
Objective:
To evaluate the association between oral care practice compliance and HAP incidence in ICU patients, and to identify specific aspects of oral care delivery that influence outcomes.
Methods:
We conducted a prospective mixed-methods observational cohort study from May 2021 across seven ICUs in a tertiary hospital in China. The study utilized a two-phase approach: (1) systematic assessment of oral care implementation through structured observation of nursing staff (n = 58), and (2) prospective evaluation of HAP outcomes in patients (n = 142). Primary outcomes included oral care compliance metrics and HAP incidence. HAP was defined according to standardized clinical criteria and confirmed by two independent physicians.
Results:
Among 142 unique patients, 63 (44.37%) received oral care orders. The oral care completion rate was 61.93%, and the qualification rate was 54.13%. In our analysis, HAP (including both ventilator-associated pneumonia [VAP] and non-ventilator hospital-acquired pneumonia [NVHAP]) occurred in 15/63 (23.81%) patients receiving oral care and 22/79 (27.85%) patients without oral care. Multivariate analysis revealed that incomplete oral care (adjusted OR 2.47, [95% CI, 1.15–4.45], P = 0.009), non-qualified care techniques (adjusted OR 3.17, [95% CI, 1.45–6.35], P = 0.002), and inadequate item qualification (adjusted OR 3.33, [95% CI, 1.47–6.55], P = 0.001) were independently associated with increased HAP risk, after adjusting for confounders. Stratified analysis showed similar associations in both VAP and NVHAP subgroups.
Conclusion:
Our investigation demonstrated that suboptimal oral care practices were associated with increased HAP risk in ICU patients. Implementation of evidence-based standardized protocols and improved adherence strategies may help reduce HAP incidence.
Coherent combining of several low-energy few-cycle beams offers a reliable and feasible approach to producing few-cycle laser pulses with energies exceeding the multi-joule level. However, time synchronization and carrier-envelope phase difference (ΔCEP) between pulses significantly affect the temporal waveform and intensity of the combined pulse, requiring precise measurement and control. Here, we propose a concise optical method based on the phase retrieval of spectral interference and quadratic function symmetry axis fitting to simultaneously measure the time synchronization and ΔCEP between few-cycle pulses. The control precision of our coherent beam combining system can achieve a time delay stability within 42 as and ΔCEP measurement precision of 40 mrad, enabling a maximum combining efficiency of 98.5%. This method can effectively improve the performance and stability of coherent beam combining systems for few-cycle lasers, which will facilitate the obtaining of high-quality few-cycle lasers with high energy.
This study investigates the stability and instability of the language control network in bilinguals using longitudinal resting-state functional magnetic resonance imaging (rs-fMRI) data. We compared the language control network of Chinese university students majoring in English with those not, using three other functional networks as controls. Results indicate that the English major group exhibits reduced stability and increased instability in the language control network compared with the non-English major group. This suggests that second language (L2) learning experience may induce adaptive neural changes. Moreover, the coexistence of stability and instability in the language control network appears less modular in the English major group, implying a more integrated response to language experience. Notably, these results were not observed in the control networks. Overall, these findings enhance the understanding of bilingual language control and the impact of L2 learning on neural plasticity.
Right anterolateral thoracotomy or left anterolateral thoracotomy applied to partial anomalous pulmonary venous connection correction have been reported to obtain cosmetic and less invasive outcomes as alternative approaches to median sternotomy. However, the application of different approaches is still confusing. We compared the perioperative and mid-term outcomes to seek indications of different approaches and guide surgical treatment of partial anomalous pulmonary venous connection.
Methods:
From July 2019 to August 2023, 44 patients who underwent surgical correction of partial anomalous pulmonary venous connection were recruited. Of these, 13 (29.6%) patients who underwent median sternotomy were separated into M group, 28 (63.6%) patients who underwent right anterolateral thoracotomy were separated into R group, and three (6.8%) patients who underwent left anterolateral thoracotomy were separated into L group. Clinical data were reviewed and compared between each group.
Results:
In M group, direct anastomosis accounted for the most (7, 53.8%), in R group, intra-atrial rerouting accounted for the most (22, 78.6%), and in L group, direct anastomosis accounted for the most (3, 100%). R group had shorter cardiopulmonary bypass time (70.0 ± 32.4 vs113.1 ± 83.3, p = 0.029), shorter ICU stay (1.0 ± 0.2 vs 1.9 ± 1.7, p = 0.01), shorter postoperative stay (6.0 ± 1.2 vs 8.3 ± 5.0, p = 0.021), and fewer chest tube drainage (8.4 ± 4.3 vs 13.9 ± 10.2, p = 0.026) compared with M group. Three left-sided partial anomalous pulmonary venous connection in L group adopted off-pump approach.
Conclusions:
Median sternotomy S.V.C. can be applicable to all anatomic types of partial anomalous pulmonary venous connection especially for complex types. Considering the minimally invasive advantages, we prefer applying right anterolateral thoracotomy for pulmonary vein connected to right atrium or proximal end of off-pump. Applying left anterolateral thoracotomy for left-sided partial anomalous pulmonary venous connection without atrial septal defect by off-pump.
Large-aperture gratings have significant applications in inertial confinement fusion, immersion lithography manufacturing and astronomical observation. Currently, it is challenging and expensive to manufacture sizable monolithic gratings. Therefore, tiled multiple small-aperture gratings are preferred. In this study, the impact of seam phase discontinuity on the modulation of the laser beam field was explored based on the measurement results of the Shenguang-II laser large-aperture multi-exposure-tiled grating. An innovative method for accurately calculating the phase jump of multi-exposure-tiled grating seams was proposed. An intensive electromagnetic field analysis was performed by applying rigorous coupled-wave analysis to a reasonably constructed micrometer-level periodic grating seam structure, and the phase jump appearing in millimeter-scale seams of large-aperture tiled gratings was obtained accurately.
Preoperative pneumonia in children with CHD may lead to longer stays in the ICU after surgery. However, research on the associated risk factors is limited. This study aims to evaluate the pre-, intra-, and postoperative risk factors contributing to extended ICU stays in these children.
Methods:
This retrospective cohort study collected data from 496 children with CHD complicated by preoperative pneumonia who underwent cardiac surgery following medical treatment at a single centre from 2017 to 2022. We compared the clinical outcomes of patients with varying ICU stays and utilised multivariate logistic regression analysis and multiple linear regression analyses to evaluate the risk factors for prolonged ICU stays.
Results:
The median ICU stay for the 496 children was 7 days. Bacterial infection, severe pneumonia, and Risk Adjustment for Congenital Heart Surgery-1 were independent risk factors for prolonged ICU stays following cardiac surgery (P < 0.05).
Conclusion:
CHD complicated by pneumonia presents a significant treatment challenge. Better identification of the risk factors associated with long-term postoperative ICU stays in these children, along with timely diagnosis and treatment of respiratory infections in high-risk populations, can effectively reduce ICU stays and improve resource utilisation.
Systemic changes in multiple diseases may influence the onset of dementia. However, the specific temporality between exposure diseases and dementia remains uncertain.
Aims
By characterising the full spectrum of temporal disease trajectories before dementia, this study aims to yield a global picture of precursor diseases to dementia and to provide detailed instructions for risk management and primary prevention of dementia.
Method
Using the multicentre, community-based prospective UK Biobank, we constructed disease trajectories before dementia utilising the phenome-wide association analysis, paired directional test and association quantification. Stratified disease trajectories were constructed by dementia subtypes, gender, age of diagnosis and Apolipoprotein E (ApoE) status, respectively.
Results
Our study population comprised 434 266 participants without baseline dementia and 4638 individuals with all-cause dementia. In total, 1253 diseases were extracted as potential components of the disease trajectory before dementia. We identified three clusters of disease trajectories preceding all-cause dementia, initiated by circulatory, metabolic and respiratory diseases occurring approximately 5–15 years before dementia. Cerebral infarction or chronic renal failure following chronic ischaemic heart disease was the specific trajectory before vascular dementia. Apolipoprotein E (ApoE) ε4 non-carriers exhibited more complex trajectories compared with carriers. Lipid metabolism disorders remained in the trajectories regardless of dementia subtypes, gender, age of diagnosis and ApoE status.
Conclusions
This study provides a comprehensive view of the longitudinal disease trajectories before dementia and highlights the potential targets of midlife cardiometabolic dysfunction for dementia screening and prevention.
Humans depend heavily on nature. Drylands are home to 2.5 billion people, but the extent to which nature contributes to people (NCP) in drylands has been little explored. We examined the global contribution of nature to people, aiming to compare drylands and non-drylands. We predicted a lower contribution in drylands than non-drylands, largely because of the sparser population densities (peoples’ needs) and more degraded status of natural resources (lower potential contribution). Consistent with expectation, nature’s contribution was about 30% lower in drylands, with significantly lower values for drylands in Asia, Oceania, Africa and South America, but no difference for Europe and North America. Differences were due mainly to lower contributions from material and regulating contributions, i.e., the regulation of air quality, climate, water quantity and flow, soil protection and the supply of woody material, and potentially, lower use by people in drylands. Predicted declines in rainfall and increasing temperature are likely to place increasing pressure on nature to contribute to human well-being in drylands. A better understanding of nature’s contributions to people would improve our ability to allocate limited resources and achieve sustainable development in drylands.
The progression of long-term diabetes complications has led to a decreased quality of life. Our objective was to evaluate the adverse outcomes associated with diabetes based on a patient’s clinical profile by utilizing a multistate modeling approach.
Methods:
This was a retrospective study of diabetes patients seen in primary care practices from 2013 to 2017. We implemented a five-state model to examine the progression of patients transitioning from one complication to having multiple complications. Our model incorporated high dimensional covariates from multisource data to investigate the possible effects of different types of factors that are associated with the progression of diabetes.
Results:
The cohort consisted of 10,596 patients diagnosed with diabetes and no previous complications associated with the disease. Most of the patients in our study were female, White, and had type 2 diabetes. During our study period, 5928 did not develop complications, 3323 developed microvascular complications, 1313 developed macrovascular complications, and 1129 developed both micro- and macrovascular complications. From our model, we determined that patients had a 0.1334 [0.1284, .1386] rate of developing a microvascular complication compared to 0.0508 [0.0479, .0540] rate of developing a macrovascular complication. The area deprivation index score we incorporated as a proxy for socioeconomic information indicated that patients who reside in more disadvantaged areas have a higher rate of developing a complication compared to those who reside in least disadvantaged areas.
Conclusions:
Our work demonstrates how a multistate modeling framework is a comprehensive approach to analyzing the progression of long-term complications associated with diabetes.
In the contemporary maritime industry, characterised by intense competition, reduced visibility due to heavy fog is a primary cause of accidents, significantly impairing maritime operational efficiency. Consequently, investigating foggy weather navigation safety holds crucial practical significance. This paper, through an analysis and synthesis of various aspects of foggy navigation technology, including foggy navigation regulations at different ports, fog warnings, foggy vessel environmental perception and foggy auxiliary navigation systems, explores the key issues concerning vessel navigation during foggy conditions from a scientific perspective. This discussion encompasses the aspects of regulatory frameworks, standardisation, and the development of intelligent and responsive onboard equipment. Finally, the paper offers a glimpse into potential strategies for fog navigation.
Nontuberculous mycobacteria (NTM) is a large group of mycobacteria other than the Mycobacterium tuberculosis complex and Mycobacterium leprae. Epidemiological investigations have found that the incidence of NTM infections is increasing in China, and it is naturally resistant to many antibiotics. Therefore, studies of NTM species in clinical isolates are useful for understanding the epidemiology of NTM infections. The present study aimed to investigate the incidence of NTM infections and types of NTM species. Of the 420 samples collected, 285 were positive for M. tuberculosis, 62 samples were negative, and the remaining 73 samples contained NTM, including 35 (8.3%) only NTM and 38 (9%) mixed (M. tuberculosis and NTM). The most prevalent NTM species were Mycobacterium intracellulare (30.1%), followed by Mycobacterium abscessus (15%) and M. triviale (12%). M. gordonae infection was detected in 9.5% of total NTM-positive cases. Moreover, this study reports the presence of Mycobacterium nonchromogenicum infection and a high prevalence of M. triviale for the first time in Henan. M. intracellulare is the most prevalent, accompanied by some emerging NTM species, including M. nonchromogenicum and a high prevalence of M. triviale in Henan Province. Monitoring NTM transmission and epidemiology could enhance mycobacteriosis management in future.
Natural sepiolite has great potential for application in wound healing, haemostasis and medicines. This paper introduces a versatile solid-state sintering technique for preparing sepiolite-based nanocomposites with enhanced antibacterial properties, and the physical, structural, rheological and antibacterial properties of which were determined to be enhanced. The incorporation of nanosized Ag and metal oxides into sepiolite composites results in a notable improvement in their antibacterial efficacy against Escherichia coli and Staphylococcus aureus in comparison to the unmodified sepiolite. With a low silver content of just 5%, the sepiolite–Ag composite achieves an antibacterial rate of ~100%. Furthermore, the rheological properties exhibited by the sepiolite composites are noteworthy, suggesting their suitability for use in wound-dressing applications due to their exceptional workability. The methodology employed in this research has the potential to offer a viable substitute for the production of economical and effective natural antibacterial nanocomposites.
Head-up tilt test (HUTT) is an important tool in the diagnosis of pediatric vasovagal syncope. This research will explore the relationship between syncopal symptoms and HUTT modes in pediatric vasovagal syncope.
Methods:
A retrospective analysis was performed on the clinical data of 2513 children aged 3–18 years, who were diagnosed with vasovagal syncope, from Jan. 2001 to Dec. 2021 due to unexplained syncope or pre-syncope. The average age was 11.76 ± 2.83 years, including 1124 males and 1389 females. The patients were divided into the basic head-up tilt test (BHUT) group (596 patients) and the sublingual nitroglycerine head-up tilt test (SNHUT) group (1917 patients) according to the mode of positive HUTT at the time of confirmed pediatric vasovagal syncope.
Results:
(1) Baseline characteristics: Age, height, weight, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and composition ratio of syncope at baseline status were higher in the BHUT group than in the SNHUT group (all P < 0.05). (2) Univariate analysis: Age, height, weight, HR, SBP, DBP, and syncope were potential risk factors for BHUT positive (all P < 0.05). (3) Multivariate analysis: syncope was an independent risk factor for BHUT positive, with a probability increase of 121% compared to pre-syncope (P<0.001).
Conclusion:
The probability of BHUT positivity was significantly higher than SNHUT in pediatric vasovagal syncope with previous syncopal episodes.
OBJECTIVES/GOALS: RNA-seq of urine and kidney allograft biopsies (bx) found that urinary cell immune landscape reflects intragraft molecular events and we discovered a shared set of 127 mRNAs in urine matched to T cell mediated and antibody mediated rejection bx. We prioritized ITM2A, SLAMF6 and IKZF3 mRNAs and herein investigate if these accurately predict rejection. METHODS/STUDY POPULATION: We collected urine samples from adult kidney allograft (KA) recipients at the time of KA bx. KA bx were classified by pathologists by Banff criteria. Total RNA was isolated from KA bx-matched urine samples. Absolute copy numbers of ITM2A, SLAMF6, and IKZF3 mRNAs and 18S rRNA were measured using our customized RT-qPCR assays. Logistic regression used to derive an equation for a combined signature score of 18S-normalized urinary cell mRNA levels of ITM2A, IKZF3, and SLAMF6 that best predicts Acute Rejection (AR= both T cell mediated rejection and antibody mediated rejection). Area under the ROC curve (AUC) was calculated to discriminate between AR and No Rejection (NR) biopsies for 18S-normalized urinary cell levels of ITM2A, IKZF3 and SLAMF6 and the composite signature score. AUCs were compared by DeLong Method. RESULTS/ANTICIPATED RESULTS: Urinary cell 18S-normalized levels of ITM2A, IKZF3, and SLAMF6 mRNAs in urine discriminated KA recipients with AR biopsies (n=95) from those with NR biopsies (n=160) (All P values <0.05, Mann-Whitney test) and the AUC was 0.69 (95%CI, 0.62 to 0.76) for ITM2A, 0.61 (95%CI, 0.53 to 0.68) for IKZF3, and 0.60 (95%CI, 0.53 to 0.68) for SLAMF6. The derived combination signature score of urinary cell 18S-normalized levels of ITM2A, IKZF3, and SLAMF6 mRNA discriminated KA recipients with AR from those with NR (P<0.0001, Mann Whitney test) and the combined signature score AUC was 0.72 (95%CI, 0.65 to 0.79). The combination signature score discriminated AR vs NR better than IKZF3 and SLAMF6 alone, but was not significantly different than ITM2A alone (DeLong method). (Additional results/figures to be included in poster) DISCUSSION/SIGNIFICANCE: Our RNA-seq offered a unique opportunity to diagnose AR by measuring the mRNAs in urine. We now found that urinary cell mRNA levels of ITM2A, IKZF3, SLAMF6 and the combined signature are diagnostic of AR, a major and serious post-transplant complication. This allows for much-needed KA molecular surveillance and personalization of immunosuppression.
To determine whether the Chinese heart-healthy diet (Sichuan cuisine version) (CHH diet-SC) was more expensive than the conventional Sichuan diet and explore the food groups and nutrients that mainly affected the cost of CHH diet-SC.
Design:
Cost analysis of 4-week intervention diets in the Sichuan center representing southwestern China in the CHH diet study.
Setting:
A multicentre, parallel-group, single-blind, randomised feeding trial evaluating the efficacy of lowering blood pressure with the cuisine-based CHH diet.
Participants:
Totally, fifty-three participants with hypertension aged 25–75 years in the Sichuan center were randomised into the control group (n 26) or the CHH diet-SC group (n 27).
Results:
The CHH diet-SC was more expensive than the control diet (¥27·87 ± 2·41 v. ¥25·18 ± 2·79 equals $3·90 ± 0·34 v. $3·52 ± 0·39, P < 0·001), and the incremental cost-effectiveness ratio for a 1-mm Hg systolic blood pressure reduction was ¥9·12 ($1·28). Intakes and the cost of seafood, dairy products, fruits, soybeans and nuts, whole grains and mixed beans were higher for the CHH diet-SC than for the control diet (P < 0·001). Intakes of vitamin B1, vitamin B6, vitamin C, Mg and phosphorus were positively correlated with the cost (P < 0·05).
Conclusions:
The CHH diet-SC costs more than the conventional Sichuan diet, partly due to the high cost of specific food groups. Positive correlations between the intakes of vitamin B1, vitamin B6, vitamin C, Mg, phosphorus and the dietary cost could be a direction to adjust the composition within the food groups to reduce the cost of the CHH diet-SC.
Selenium (Se) is an essential micronutrient for human health, and Se concentration of wheat grain in China has no significant relationships with selenium concentration of wheat and with soil organic matter, nitrogen, phosphorus, potassium in the 0–20 cm soil layer. However, a significant indigenous positive correlation was found with soil Se concentration. Field experiments were conducted from 2018 to 2020 to clarify the differences in the Se accumulation in wheat plants grown in Se-rich areas. We used two common wheat (ZM-175, SN-20), two purple wheat (JZ-496, ZM-8555), and two black wheat (YH-161, LH-131) cultivars to investigate changes in Se build-up and transportation in plant organs. The grain Se concentration of six wheat genotypes in Se-rich areas varied between 178 and 179 μg Se kg−1, with organic Se accounting for 87 to 91%. All genotypes had more than 150 μg Se kg−1, the standard Se concentration in grains. Purple grain wheat had the highest total and organic Se concentrations. Purple wheat also exhibited significantly higher Se transfer coefficient in roots, stem and leaves, and glumes, when compared to common wheat. Moreover, purple wheat had the highest Se uptake efficiency (e.g., JZ-496 with 31%) when compared to common wheat and black wheat. Regardless of the color, wheat grains met the Se-enriched criteria (150 μg Se kg−1) when grown in a natural Se-enriched area. Due to higher Se uptake and accumulation, purple wheat grain genotypes, such as JZ-496, are recommended for wheat breeding programs aiming for high Se functional foods.
This study aims to gain insight into each attribute as presented in the value of implantable medical devices, quantify attributes’ strength and their relative importance, and identify the determinants of stakeholders’ preferences.
Methods
A mixed-methods design was used to identify attributes and levels reflecting stakeholders’ preference toward the value of implantable medical devices. This design combined literature reviewing, expert’s consultation, one-on-one interactions with stakeholders, and a pilot testing. Based on the design, six attributes and their levels were settled. Among 144 hypothetical profiles, 30 optimal choice sets were developed, and healthcare professionals (decision-makers, health technology assessment experts, hospital administrators, medical doctors) and patients as stakeholders in China were surveyed. A total of 134 respondents participated in the survey. Results were analyzed by mixed logit model and conditional logit model.
Results
The results of the mixed logit model showed that all the six attributes had a significant impact on respondents’ choices on implantable medical devices. Respondents were willing to pay the highest for medical devices that provided improvements in clinical safety, followed by increased clinical effectiveness, technology for treating severe diseases, improved implement capacity, and innovative technology (without substitutes).
Conclusions
The findings of DCE will improve the current evaluation on the value of implantable medical devices in China and provide decision-makers with the relative importance of the criteria in pricing and reimbursement decision-making of implantable medical devices.
The poor environmental stability of natural anthocyanin hinders its usefulness in various functional applications. The objectives of the present study were to enhance the environmental stability of anthocyanin extracted from Lycium ruthenicum by mixing it with montmorillonite to form an organic/inorganic hybrid pigment, and then to synthesize allochroic biodegradable composite films by incorporating the hybrid pigment into sodium alginate and test them for potential applications in food testing and packaging. The results of X-ray diffraction, Fourier-transform infrared spectroscopy, and use of the Brunauer–Emmett–Teller method and zeta potential demonstrated that anthocyanin was both adsorbed on the surface and intercalated into the interlayer of montmorillonite via host–guest interaction, and the hybrid pigments obtained allowed good, reversible, acid/base behavior after exposure to HCl and NH3 atmospheres. The composite films containing hybrid pigments had good mechanical properties due to the uniform dispersion of the pigments in a sodium alginate substrate and the formation of hydrogen bonds between them. Interestingly, the composite films also exhibited reversible acidichromism. The as-prepared hybrid pigments in composite films could, therefore, serve simultaneously as a reinforced material and as a smart coloring agent for a polymer substrate.
This study aimed to investigate the structural and metabolic changes in cumulus cells of underweight women and their effects on oocyte maturation and fertilization. The cytoplasmic ultrastructure was analyzed by electron microscopy, mitochondrial membrane potential by immunofluorescence, and mitochondrial DNA copy number by relative quantitative polymerase chain reaction. The expression of various proteins including the oxidative stress-derived product 4-hydroxynonenal (4-HNE) and autophagy and apoptosis markers such as Vps34, Atg-5, Beclin 1, Lc3-I, II, Bax, and Bcl-2 was assessed and compared between groups. Oocyte maturation and fertilization rates were lower in underweight women (P < 0.05), who presented with cumulus cells showing abnormal mitochondrial morphology and increased cell autophagy. Compared with the mitochondrial DNA copies of the control group, those of the underweight group increased but not significantly. The mitochondrial membrane potential was similar between the groups (P = 0.8). Vps34, Atg-5, Lc3-II, Bax, and Bcl-2 expression and 4-HNE levels were higher in the underweight group compared with the control group (P < 0.01); however, the Bax/Bcl-2 ratio was lower in the underweight group compared with the control group (P = 0.031). Additionally, Beclin 1 protein levels were higher in the underweight group compared with the control group but without statistical significance. In conclusion, malnutrition and other conditions in underweight women may adversely affect ovulation, and the development, and fertilization of oocytes resulting from changes to the intracellular structure of cumulus cells and metabolic processes. These changes may lead to reduced fertility or unsatisfactory reproduction outcomes in women.