Going to work sick: A scoping review of illness presenteeism among physicians and medical trainees.

BACKGROUND: Illness presenteeism (IP)-characterized by individuals working despite being sick-is a prevalent and complex phenomenon among physicians and trainees amidst competing priorities within medicine. The COVID-19 pandemic and growing attention to physician and trainee well-being have sparked renewed interest in IP. We conducted a scoping review to explore what is known about IP: more specifically, how IP is perceived, what approaches have been used to study the phenomenon and how it might have changed through the COVID-19 pandemic. METHOD: The Arksey and O'Malley scoping review framework was used to systematically select and summarize the literature. Searches were conducted across four databases: Medline, Embase, PsycInfo and Web of Science. Quantitative and thematic analyses were conducted. RESULTS: Of 4277 articles screened, 45 were included. Of these, four were published after the onset of the COVID-19 pandemic. All studies framed IP as problematic for physicians, patients and health care systems. Dominant sociocultural drivers of IP included obligations towards patients and colleagues and avoiding the stigma of appearing vulnerable or even temporarily weak. Structural factors included heavy workload, poor access to health services and lack of sick leave policies for physicians. The pandemic does not appear to have affected IP-related causes or behaviours. Proposed solutions included both educational interventions and policy-driven changes. CONCLUSIONS: Despite being viewed in the literature as largely negative, IP remains highly prevalent among physicians and trainees. Our review highlights that IP among physicians is fraught with tensions: while IP seemingly contradicts certain priorities such as physician wellbeing, IP may be justified by fulfilling obligations to patients and colleagues. Future work should examine IP through diverse theoretical lenses to further elucidate its complexities and inform nuanced individual and systems-level interventions to minimize the negative consequences of IP.

Association of the oxidative balance score and chronic kidney disease: insights from the national health and nutrition examination survey 2009-2018.

Introduction: Oxidative stress plays a pivotal role in the pathogenesis of chronic kidney disease (CKD). The oxidative balance score (OBS) was devised to quantify the overall oxidative state, integrating pro-oxidant and antioxidant influences from both dietary intake and lifestyle practices. The aim of this study was to delve into the relationship between the OBS and CKD within the adult population of the United States. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2009-2018, we derived the OBS from 16 dietary and four lifestyle factors. We employed weighted multivariate regression to probe the link between OBS and CKD. Additionally, we undertook subgroup analyses and applied Restricted Cubic Spline Regression (RCS) for further data analyses. Results: This study encompassed 19,444 participants. Logistic regression analysis consistently demonstrated a protective effect of higher OBS on CKD. In Model 3, each unit increase in OBS was associated with a 2% reduction in the risk of CKD (95% CI: 0.97-0.99, p < 0.001) and a 4% reduction in the risk of reduced estimated glomerular filtration rate (eGFR) (95% CI: 0.95-0.98, p < 0.001). The highest OBS quintile (Q4) also showed significant reductions in the risk of CKD (OR: 0.66, 95% CI: 0.53-0.82, p < 0.001) and reduced eGFR (OR: 0.51, 95% CI: 0.37-0.69, p < 0.001) in Model 3. RCS analysis revealed a linear relationship between OBS and CKD. Subgroup analyses indicated significant associations between OBS and CKD in most subgroups, except for those without hypertension or with cardiovascular disease. Additionally, interaction analyses demonstrated that age, hypertension, and diabetes significantly modify the association between OBS and CKD risk. Conclusion: An elevated OBS, reflecting a predominance of antioxidants, correlates with a diminished CKD risk in the American adult demographic. These insights emphasize the potential influence of oxidative equilibrium on the development of CKD.

An analysis of the burden of liver cirrhosis: Differences between the global, China, the United States and India.

BACKGROUND: Cirrhosis continues to be the most common cause of chronic liver disease-related deaths globally, which puts significant strain on global health. This report aims to investigate the patterns of cirrhosis in China, the United States, India and worldwide from 1990 to 2019 through an epidemiological analysis of the disease utilizing data from the Global Burden of Disease Study (GBD) 2019 database. METHODS: Download the GBD database's statistics on liver cirrhosis deaths and Disability-Adjusted Life Years for the years 1990-2019 worldwide as well as for China, the United States and India. Utilize techniques like age-period-cohort interaction, decomposition analysis, study of health inequities, Joinpoint model and Bayesian Average Annual Percentage Change model to process the data. RESULTS: The main age group affected by cirrhosis disease, according to the results, is 50-69 years old. According to the Joinpoint model, there has been a negative worldwide Average Annual Percent Change (AAPC) in the burden of cirrhosis between 1990 and 2019. Only the USA's AAPC is positive out of the three nations that were evaluated (albeit its 95% confidence interval spans 0). These are China, India and the United States. Forecasting models indicate that the prevalence of cirrhosis will keep rising in the absence of government action. According to decomposition analysis, the main factors contributing to the rising burden of cirrhosis are population ageing and size, whereas changes in the disease's epidemiology slow the disease's growth. Research on health disparities indicates that, between 1990 and 2019, there was a downward trend in health disparities between various locations. CONCLUSION: Health organizations across different areas should take aggressive measures to address the worrisome prevalence of cirrhosis.

Exploration of the potential mechanism of aqueous extract of Artemisia capillaris for the treatment of non-alcoholic fatty liver disease based on network pharmacology and experimental verification.

OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is a nutritional and metabolic disease with a high prevalence today. Artemisia capillaris has anti-inflammatory, antioxidant, and other effects. However, the mechanism of A. capillaris in treating NAFLD is still poorly understood. METHODS: This study explored the mechanism of A. capillaris in the treatment of NAFLD through network pharmacology and molecular docking, and verified the results through in vivo experiments using a high-fat diet-induced mouse model and in vitro experiments using an oleic acid-induced HepG2 cell model. KEY FINDINGS: Aqueous extract of A. capillaris (AEAC) can reduce blood lipids, reduce liver lipid accumulation and liver inflammation in NAFLD mice, and improve NAFLD. Network pharmacology analysis revealed that 51 drug ingredients in A. capillaris correspond to 370 targets that act on NAFLD. GEO data mining obtained 93 liver differentially expressed genes related to NAFLD. In the UHPLC-MS detection results, 36 components were characterized and molecular docked with JNK. Verified in vitro and in vivo, the results show that JNK and the phosphorylation levels of IL-6, IL-1ß, c-Jun, c-Fos, and CCL2 are key targets and pathways. CONCLUSIONS: This study confirmed that AEAC reduces lipid accumulation and inflammation in the liver of NAFLD mice by inhibiting the JNK/AP-1 pathway.

The reduced frequency of CD39+CD73+ B cell subsets in SLE patients is correlated with disease activity.

BACKGROUND: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease characterized by immune mechanisms dysregulation, leading to the production of diverse autoantibodies. However, the immune pathways underlying B-cell function and phenotypic abnormalities related to SLE pathogenesis remain incompletely understood. OBJECTIVE: To explore new markers of SLE activity and potential targets for SLE immunotherapy. METHODS: Collect peripheral blood mononuclear cells (PBMCs) from SLE patients and healthy controls (HC). Use flow cytometry to detect CD39 and CD73 expression on B cell subsets and enzyme-linked immunosorbent assay (ELISA) to measure adenosine (ADO) concentrations in SLE patients' serum. Compare CD39+CD73+ B cell subsets frequency and ADO concentrations in SLE patients and HC group. Additionally, analyze the correlation between CD39+CD73+ B cell subsets frequency and clinical laboratory parameters. RESULTS: CD39 and CD73 are simultaneously highly expressed on CD19+ B cell subsets, with significantly lower frequency of CD39+CD73+ B cell subsets in SLE patients compared to HC group. This frequency negatively correlates with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), C-reactive protein (CRP), and anti-double-stranded DNA (anti-dsDNA) antibodies, while positively correlating with IgM and prothrombin time (PT). Additionally, the frequency of CD39+CD73+ B cell subsets is significantly negatively correlated with IL-6 and IFN-α. In vitro cell experiments demonstrate that adenosine significantly inhibits R848-induced inflammatory cytokine production in a dose-dependent manner. CONCLUSION: The frequency of CD39+CD73+ B cell subsets of SLE patients is decreased, correlating with clinical laboratory parameters and disease activity. Simultaneously, ADO concentration in the patients' serum is reduced. The CD39+CD73+ B cell/ADO pathway may represent a novel immunotherapy strategy for SLE.

Tauroursodeoxycholic Acid Improves Nonalcoholic Fatty Liver Disease by Regulating Gut Microbiota and Bile Acid Metabolism.

Tauroursodeoxycholic acid (TUDCA) is a synthetic bile salt that has demonstrated efficacy in the management of hepatobiliary disorders. However, its specific mechanism of action in preventing and treating nonalcoholic fatty liver disease (NAFLD) remains incompletely understood. This research revealed that TUDCA treatment can reduce obesity and hepatic lipid buildup, enhance intestinal barrier function and microbial balance, and increase the presence of Allobaculum and Bifidobacterium in NAFLD mouse models. TUDCA can influence the activity of farnesoid X receptor (FXR) and cholesterol 7α-hydroxylase (CYP7A1), resulting in higher hepatic bile acid levels and increased expression of sodium taurocholate cotransporting polypeptide (NTCP), leading to elevated concentrations of liver-bound bile acids in mice. Furthermore, TUDCA can inhibit the expression of FXR and fatty acid transport protein 5 (FATP5), thereby reducing fatty acid absorption and hepatic lipid accumulation. This investigation provides new insights into the potential of TUDCA for preventing and treating NAFLD.

Iron-dependent KDM4D activity controls the quiescence-activity balance of MSCs via the PI3K-Akt-Foxo1 pathway.

Iron deficiency is a prevalent nutritional deficit associated with organ damage and dysfunction. Recent research increasingly associates iron deficiency with bone metabolism dysfunction, although the precise underlying mechanisms remain unclear. Some studies have proposed that iron-dependent methylation-erasing enzyme activity regulates cell proliferation and differentiation under physiological or pathological conditions. However, it remains uncertain whether iron deficiency inhibits the activation of quiescent mesenchymal stem cells (MSCs) by affecting histone demethylase activity. In our study, we identified KDM4D as a key player in the activation of quiescent MSCs. Under conditions of iron deficiency, the H3K9me3 demethylase activity of KDM4D significantly decreased. This alteration resulted in increased heterochromatin with H3K9me3 near the PIK3R3 promoter, suppressing PIK3R3 expression and subsequently inhibiting the activation of quiescent MSCs via the PI3K-Akt-Foxo1 pathway. Iron-deficient mice displayed significantly impaired bone marrow MSCs activation and decreased bone mass compared to normal mice. Modulating the PI3K-Akt-Foxo1 pathway could reverse iron deficiency-induced bone loss.

Application of Diffusion Kurtosis Imaging and Blood Oxygen Level-Dependent Magnetic Resonance Imaging in Kidney Injury Associated with ANCA-Associated Vasculitis.

OBJECTIVE: Functional magnetic resonance imaging (fMRI) has been applied to assess the microstructure of the kidney. However, it is not clear whether fMRI could be used in the field of kidney injury in patients with Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS: This study included 20 patients with AAV. Diffusion kurtosis imaging (DKI) and blood oxygen level-dependent (BOLD) scanning of the kidneys were performed in AAV patients and healthy controls. The mean kurtosis (MK), mean diffusivity (MD), and fractional anisotropy (FA) parameters of DKI, the R2* parameter of BOLD, and clinical data were further analyzed. RESULTS: In AAV patients, the cortex exhibited lower MD but higher R2* values compared to the healthy controls. Medullary MK values were elevated in AAV patients. Renal medullary MK values showed a positive correlation with serum creatinine levels and negative correlations with hemoglobin levels and estimated glomerular filtration rate. To assess renal injury in AAV patients, AUC values for MK, MD, FA, and R2* in the cortex were 0.66, 0.67, 0.57, and 0.55, respectively, and those in the medulla were 0.81, 0.77, 0.61, and 0.53, respectively. CONCLUSIONS: Significant differences in DKI and BOLD MRI parameters were observed between AAV patients with kidney injuries and the healthy controls. The medullary MK value in DKI may be a noninvasive marker for assessing the severity of kidney injury in AAV patients.

Catalpol from Rehmannia glutinosa Targets Nrf2/NF-κB Signaling Pathway to Improve Renal Anemia and Fibrosis.

Rehmannia glutinosa is widely recognized as a prominent medicinal herb employed by practitioners across various generations for the purpose of fortifying kidney yin. Within Rehmannia glutinosa, the compound known as catalpol (CAT) holds significant importance as a bioactive constituent. However, the protective effects of CAT on kidneys, including ameliorative effects on chronic kidney disease - most prominently renal anemia and renal fibrosis - have not been clearly defined. In this study, the kidney injury model of NRK-52E cells and C57BL/6N male mice was prepared by exposure to aristolochic acid I (AA-I), and it was discovered that CAT could ameliorate oxidative stress injury, inflammatory injury, apoptosis, renal anemia, renal fibrosis, and other renal injuries both in vivo and in vitro. Further treatment of NRK-52E cells with Nrf2 inhibitors (ML385) and activators (ML334), as well as NF-κB inhibitors (PDTC), validated CAT's ability to target Nrf2 activation. Furthermore, the expression of phosphorylated NF-κB p65, IL-6, and Cleaved-Caspase3 protein was inhibited. CAT also inhibited NF-κB, and then inhibited the expression of IL-6, p-STAS3, TGF-ß1 protein. Therefore, CAT can regulate Nrf2/NF-κB signaling pathway, significantly correct renal anemia and renal fibrosis, and is conducive to the preservation of renal structure and function, thus achieving a protective effect on the kidneys.

Potential of exogenous melatonin administration to mitigate heat stress induce pathophysiology of chicken.

Melatonin (MT) is an amine hormone secreted by the body that has antioxidant and anti-inflammatory properties. The aim of this study was to investigate pathophysiological protection of MT in heat-stressed chickens. By modelling heat-stressed chickens and treating them with MT. After 21 days of administration, serum antioxidant enzymes, biochemical indices, inflammatory cytokine and heat-stress indices were detected, along with cardiopulmonary function indices and histological observations in chickens. The results show heat-stress induced a decrease (P < 0.05) in body weight and an increase in body temperature, which was reversed after MT intervention. Treatment with MT inhibited (P < 0.05) the secretion of pro-inflammatory factors interleukin-1ß, interleukin-6, tumor necrosis factor α, serum heat shock protein 70, corticosterone, and elevated (P < 0.05) the levels of biochemical factors total protein, albumin, globulin, and increased (P < 0.05) the activities of antioxidant enzymes superoxide dismutase, glutathione peroxidase and catalase in chicken serum caused by heat stress, and the best effect was observed with the medium dose of MT. The heat-stress caused cardiac atrophy and pulmonary congestion, decreased (P < 0.05) the cardiac function indices creatine kinase isoenzyme, cardiac troponin I, angiotensin receptor I, creatine kinase and lung function indices myeloperoxidase, angiotensin-II, heat shock factor I, and increased (P < 0.05) the lung vascular endothelial growth factor II. Sections of the heart and lungs after administration of MT were observed to be more complete with more normal tissue indices. At the same time, compared with heat stress, heart and lung function indices of grade chickens after MT administration were significantly (P < 0.05)reduced and tended to normal levels, and the best effect was observed in the medium-dose MT. In conclusion, heat stress can cause pathophysiological damage in chickens, and 1 mg/kg/d of exogenous melatonin can attenuate this adverse effect.

Fear of progression among colorectal cancer patients: a latent profile analysis.

PURPOSE: Fear of progression (FoP) leads to poor clinical outcomes in colorectal cancer patients. The study aimed to clarify the profiles and influencing factors of FoP among colorectal cancer patients. METHODS: A cross-sectional study was conducted with 409 colorectal cancer patients. Convenience sampling method was used to select colorectal cancer patients hospitalized in a tertiary-level hospital in Nanjing as the survey subjects. General information questionnaire, Fear of Progression Questionnaire-Short Form, Distress Disclosure Index, and Social Support Rating Scale were used to collect the data. Latent profile analysis was used to explore the latent profiles of FoP in colorectal cancer patients. Additionally, the influencing factors of profiles were explored by Univariate Analysis and Binomial Logistic Regression Analysis. RESULTS: Latent profile analysis identified two subgroups of fear of disease progression: the "fear low-risk profile (83%)", and the "severe fear profile (17%)." Patients with low age, low social support utilization, first hospital admission, severe healthcare burden, and preoperative bowel symptoms were prone to severe fear of disease progression. CONCLUSIONS: There is some heterogeneity in the level of postoperative fear of disease progression in colorectal cancer patients. Doctors and nurses should focus on patients with severe fear and take targeted preventive and psychological care for patients' fear of disease progression as early as possible according to the distribution characteristics of different categories.

Synthesis of a novel Si-N-S flame retardant and its application on cotton cellulose biomacromolecule.

A novel flame retardant containing Si, N, and S elements, ((2-(triethoxysilyl)ethyl)thio)ethan-1-amine hydrochloride (TETEA), was synthesized via a click reaction and characterized using nuclear magnetic resonance spectroscopy (NMR) and fourier transform infrared spectroscopy (FTIR). Subsequently, the flame-retardant cotton fabric was fabricated by sol-gel method. The results indicated that TETEA was successfully loaded on cotton fabric and formed a uniform protective layer on the surface of cotton fabric, exhibiting excellent flame retardancy. The flame-retardant cotton fabric achieved limiting oxygen index (LOI) of 28.3 % and passed vertical combustion test without after-flame or afterglow time at TETEA concentration of 500 g/L. Thermogravimetric analysis revealed that the residual carbon content of the flame-retardant cotton fabric was much higher than that of the control under air and N2 conditions. Besides, the flame-retardant cotton fabric was not ignited in cone calorimeter test with an external heat flux of 35 kW/m2. The peak heat release rate and the total heat release decreased from 133.4 kW/m2 to 25.8 kW/m2 and from 26.46 MJ/m2 to 17.96 MJ/m2, respectively. This phosphorus-free flame retardant offers a simplified synthesis process without adverse environmental impacts, opening up a new avenue for the development environmentally friendly flame retardants compared to traditional alternatives.

The Role of Microglia with Mitochondrial Dysfunction and Its Therapeutic Prospects in Alzheimer's Disease.

Alzheimer's disease (AD), a primary cause of dementia, is rapidly emerging as one of the most financially taxing, lethal, and burdensome diseases of the 21st century. Increasing evidence suggests that microglia-mediated neuroinflammation plays a key role in both the initiation and progression of AD. Recently, emerging evidence has demonstrated mitochondrial dysfunction, particular in microglia where precedes neuroinflammation in AD. Multiple signaling pathways are implicated in this process and pharmaceutical interventions are potentially involved in AD treatment. In this review, advance over the last five years in the signaling pathways and pharmaceutical interventions are summarized and it is proposed that targeting the signaling pathways in microglia with mitochondrial dysfunction could represent a novel direction for AD treatment.

Investigation into fabrication and optical characteristics of tunable optofluidic microlenses using two-photon polymerization.

Optofluidic systems, integrating microfluidic and micro-optical technologies, have emerged as transformative tools for various applications, from molecular detection to flow cytometry. However, existing optofluidic microlenses often rely on external forces for tunability, hindering seamless integration into systems. This work presents an approach using two-photon polymerization (TPP) to fabricate inherently tunable microlens arrays, eliminating the need for supplementary equipment. The optofluidic design incorporates a three-layered structure enabling dynamic manipulation of refractive indices within microchannels, leading to tunable focusing characteristics. It is shown that the TPP fabricated optofluidic microlenses exhibit inherent tunable focal lengths, numerical apertures, and spot sizes without reliance on external forces. This work signifies some advancements in optofluidic technology, offering precise and tunable microlenses with potential applications in adaptive imaging and variable focal length microscopy.

Acetyl-11-keto-beta-boswellic acid modulates macrophage polarization and Schwann cell migration to accelerate spinal cord injury repair in rats.

BACKGROUND: Inhibiting secondary inflammatory damage caused by glial cells and creating a stable microenvironment is one of the main strategies to investigate drugs for the treatment of spinal cord injury. Acetyl-11-keto-beta-boswellic acid (AKBA) is the active component of the natural drug boswellia, which has anti-inflammatory and antioxidant effects and offers a possible therapeutic option for spinal cord injury. METHODS: In this study, a spinal cord injury model was established by crushing spinal cord, respectively, to detect the M1 macrophage inflammatory markers: iNOS, TNF-α, IL-1ß, and the M2 macrophage markers CD206, ARG-1, IL-10, and the detection of antioxidant enzymes and MDA. In vitro, macrophages were cultured to verify the main mechanism of the macrophage switch from Nrf2/HO-1 to M2 type by flow cytometry, immunofluorescence, and other techniques. Macrophage and Schwann cell co-culture validated the migration mechanism of Schwann cells promoted by AKBA. RESULTS: AKBA significantly enhanced the antioxidant enzyme activities of CAT, GSH-Px, T-AOC, and SOD, reduced MDA content, and reduced oxidative damage caused by spinal cord injury via the Nrf2/HO-1 signaling pathway; AKBA mediates Nrf2/HO-1/IL-10, converts macrophages from M1 to M2 type, reduces inflammation, and promotes Schwann cell migration, thereby accelerating the repair of spinal cord injury in rats. CONCLUSIONS: Our work demonstrates that AKBA can attenuate oxidative stress as well as the secondary inflammatory injury caused by macrophages after SCI, promote Schwann cell migration to the injury site, and thus accelerate the repair of the injured spinal cord.

CYP7B1-mediated 25-hydroxycholesterol degradation maintains quiescence-activation balance and improves therapeutic potential of mesenchymal stem cells.

Stem cells remain quiescent in vivo and become activated in response to external stimuli. However, the mechanism regulating the quiescence-activation balance of bone-marrow-derived mesenchymal stem cells (BM-MSCs) is still unclear. Herein, we demonstrated that CYP7B1 was the common critical molecule that promoted activation and impeded quiescence of BM-MSCs under inflammatory stimulation. Mechanistically, CYP7B1 degrades 25-hydroxycholesterol (25-HC) into 7α,25-dihydroxycholesterol (7α,25-OHC), which alleviates the quiescence maintenance effect of 25-HC through Notch3 signaling pathway activation. CYP7B1 expression in BM-MSCs was regulated by NF-κB p65 under inflammatory conditions. BM-MSCs from CYP7B1 conditional knockout (CKO) mice had impaired activation abilities, relating to the delayed healing of bone defects. Intravenous infusion of BM-MSCs overexpressing CYP7B1 could improve the pathological scores of mice with collagen-induced arthritis. These results clarified the quiescence-activation regulatory mechanism of BM-MSCs through the NF-κB p65-CYP7B1-Notch3 axis and provided insight into enhancing BM-MSCs biological function as well as the subsequent therapeutic effect.

Analysis of Thyroid Function in ANCA-Associated Vasculitis Patients with Renal Injury.

BACKGROUND: Previous studies indicated common thyroid dysfunction in various kidney diseases. This study aimed to investigate the thyroid function in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with renal injury. METHODS: Briefly, 174 patients diagnosed as having AAV with renal injury and without previous thyroid disease history were included in the retrospective and prospective study. The clinical parameters were collected and compared between different groups. RESULTS: Of the patients included, 24 exhibited normal thyroid function, while 150 had thyroid dysfunction, including 55 (36.67%) with hypothyroidism. Those AAV patients with thyroid dysfunction showed different clinical parameters from those with normal thyroid function. The patients were followed up for a median of 68.6 (64.3; 72.8) months. Those with thyroid dysfunction were more prone to progressing to dialysis dependence compared to the group with normal thyroid function. Logistic regression analysis showed advanced age and decreased albumin as independent risk factors for thyroid dysfunction in patients with AAV. Survival analysis and multivariate Cox regression analysis showed that thyroid dysfunction was a risk factor for AAV patients with renal injury to progress to the endpoint of dialysis dependence. CONCLUSION: Thyroid dysfunction, predominantly hypothyroidism, was commonly complicated in AAV patients with renal injury. AAV patients with thyroid dysfunction were presented with different clinical parameters and more prone to progressing to dialysis dependence compared to those with normal thyroid function.

Enhancer-mediated FOXO3 expression promotes MSC adipogenic differentiation by activating autophagy.

BACKGROUND: Mesenchymal stem cells (MSCs) are pluripotent stem cells capable of differentiating into osteocytes, adipocytes and chondrocytes. However, in osteoporosis, the balance of differentiation is tipped toward adipogenesis and the key mechanism is controversial. Researches have shown that, as upstream regulatory elements of gene expression, enhancers ar involved in the expression of identity genes. In this study, we identified enhancers-mediated gene FOXO3 promoting MSC adipogenic differentiation by activating autophagy. METHODS: We integrated data of RNA sequencing (RNA-seq), chromatin immunoprecipitation sequencing (ChIP-seq) and ATAC-sequencing (ATAC-seq) to find the identity gene FOXO3. The expression of FOXO3 protein, adipogenic transcription factors and the substrate of autophagy were measured by western blotting. The Oil Red O (ORO) staining was used to visualize the adipogenesis of MSCs. Immunohistochemistry was used to visualize the FOXO3 expression in adipocytes in bone marrow. Immunofluorescence was used to detect the expression of PPARγ and LC3B. RESULTS: During adipogenesis, enhancers redistribute to genes associated with adipogenic differentiation, among which we identified the pivotal identity gene FOXO3. FOXO3 could promote the expression of the adipogenic transcription factors PPARγ, CEBPα, and CEBPß during adipogenic differentiation, while PPARγ, CEBPα, and CEBPß could in turn bind to FOXO3 and continue to promote FOXO3 expression to form a positive feedback loop. Consistently elevated FOXO3 expression promotes autophagy by activating the PI3K-AKT pathway which mediates adipogenic differentiation. CONCLUSIONS: Pivotal identity gene FOXO3 promotes autophagy by activating PI3K-AKT pathway, which provokes adipogenic differentiation of MSCs. Enhancer-regulated adipogenic identity gene FOXO3 could be an attractive treatment for osteoporosis.