Carica papaya Linn have nutritional properties that mean it can be used as an adjuvant for the treatment of various pathologies. Methods: The fatty acid composition of the oil extracted from the seeds of Carica papaya Linn was evaluated by gas chromatography, and an acute toxicity test was performed. For the experiment, Swiss mice were fed a balanced or high-fat diet and supplemented with saline, soybean oil, olive oil, or papaya seed oil. Oral glucose tolerance and insulin sensitivity tests were performed. After euthanasia, adiposity, glycemia, total cholesterol and fractions, insulin, resistin, leptin, MCP-1, TNF-α, and IL-6 and the histology of the liver, pancreas, and adipose tissue were evaluated. Results: Papaya seed oil showed predominance of monounsaturated fatty acids in its composition. No changes were observed in the acute toxicity test. Had lower food intake in grams, and caloric intake and in the area of adipocytes without minimizing weight gain or adiposity and impacting the liver or pancreas. Reductions in total and non-HDL-c, LDL-c, and VLDL-c were also observed. The treatment had a hypoglycemic and protective effect on insulin resistance. Supplementation also resulted in higher leptin and lower insulin and cytokine resistance. Conclusions: Under these experimental conditions, papaya seed oil led to higher amounts of monounsaturated fatty acids and had hypocholesterolemic, hypotriglyceridemic, and hypoglycemic effects.Background: Studies indicate that different parts of  America is home to 124,933 species of plants, distributed in 6227 genera and 355 families [In this sense, the investigation of fruits and their therapeutic applicability has gained ground due to their wide consumption and their presentation of a useful nutritional composition that includes fibers, vitamins, minerals, and phytochemical compounds  that manifest several health effects .Carica papaya Linn), which was discovered in southern Mexico and northern Nicaragua, was brought to Brazil in 1587, showing excellent adaptation to the local climate and becoming the most produced and commercialized fruit, transforming Brazil into one of its main world producers, together with the mentioned countries [Papaya  , a singl−1, respectively [−1, and when carotenoids were quantified, β-Cryptoxanthin (4.29 mg·kg−1) and β-carotene (2.76 mg·kg−1) were found [Studies have shown that papaya seed extract has a bioactive component, benzyl isothiocyanate, and contains significant amounts of glucosinolates, which have an inhibiting action on the development of cancer  and vermectively . The conre found ,16, in are found .In the fatty acid profile, oleic fatty acid is predominant in the seeds (71.30%), followed by palmitic 16.16%), linoleic (6.06%), and stearic fatty acids ,15,16..16%, linObesity and the accompanying metabolic disorders characterize metabolic syndrome. Among the various treatments proposed, the use of products obtained from plants or fruits has been reported since antiquity, as they present high concentrations of vitamins, bioactive compounds, and a lipid composition that reduces inflammatory markers and platelet aggregation and protects against thrombogenesis and oxidative stress, in addition to preventing hypercholesterolemia and hypertriglyceridemia . So, plaCarica papaya Linn in animals receiving a high-fat diet. The study may contribute to the discovery of a new biological resource for the prevention and/or treatment of obesity and its comorbidities, as well as contributing to an increase in papaya productivity, benefiting the economy, as well as encouraging the use of discarded fruit waste.Considering the composition of papaya seeds, their use can be beneficial for the prevention and/or treatment of obesity and associated metabolic disorders; however, as yet, there is no evidence of the possible effect of papaya oil on obesity and metabolic disorders. As such, the objective of this study is to evaluate the therapeutic effects of oil from the seeds of In the analysis of fatty acid composition, higher concentrations of monounsaturated fatty acids (74.75%) were observed, with oleic acid predominating (C18:1ω9) at 72.93% (±0.01). Among the saturated fatty acids (20.57%), there was a predominance of palmitic acid (C16:0) at 16.95% (±0.09). These were followed by polyunsaturated fatty acids (4.16%), with higher concentrations of linoleic acid (C18:2ω6)—3.64% (±0.02) .Carica papaya Linn), with a dose of 5000 mg/kg administered to healthy animals (Group OM), did not cause any change in the behavioral parameters analyzed compared to animals supplemented with only saline (Group CT), and there was no significant difference in food and water consumption between groups.In the acute toxicity test, the seed oil of papaya (There were no deaths over the 14-day period (acute toxicity) of observation. The body weights of the animals, as well as the weights of the liver, spleen, kidneys, lungs, and heart, did not show significant differences when comparing the groups, and no macroscopic alterations were observed (data not shown).p < 0.01). In the second month, the HPL OM still presented lower consumption (grams), but with a difference in relation to the CT, AIN-93, and HPL groups (p < 0.01). There was a difference in total consumption when compared to the CT and AIN-93 groups (p < 0.001); that is, throughout the experiment, the HPL OM group presented lower food consumption (grams) when compared to the CT and AIN-93 groups  (data not shown).Regarding caloric intake, it was observed that in the third, fifth, and eighth weeks of supplementation, the animals that received papaya seed oil had lower caloric intake, with a significant difference when compared to the CT and HPL groups (p = 0.938)  .p < 0.05). The difference between the HPL OM (36.7 g) and HPL group (43.2 g) persisted in the second week of evaluation (p < 0.05).One week after the change in diet and supplementation, the HPL OM group (35.3 g) showed lower weight gain and a statistical difference compared to the HPL (41.8 g) and HPL OS (40.9 g) groups  at the sites of epididymal, perirenal, retroperitoneal, mesenteric, and omental adipose tissue, the l groups .However, when evaluating the adipocytes area, the group that received papaya seed oil presented lower values with a statistical difference from the HPL, HPL OS, and HPL AZ groups .p = 0.002)  .p = 0.008). As regards non-HDL cholesterol, the HPL OM group obtained lower values, with statistical difference when compared to the HPL group (p < 0.001).When verifying the HDL cholesterol values, only the HPL OM group presented high values with a statistical difference from the AIN 93 group (p < 0.001). In the assessment of VLDL cholesterol, the HPL OM group presented lower values, with a statistical difference when compared to the HPL group (p = 0.038).The triglyceride values showed no significant difference between the groups; on the other hand, lower LDL cholesterol values were found in HPL OM, with a statistical difference when compared to HPL, AIN-93, and HPL OS  and similar values to CT and AIN-93  (data not shown). The results of the oral glucose tolerance test and the insulin sensitivity test were confirmed by performing an analysis of the area under the curve of both tests   A.p < 0.001).In the quantification of insulin and resistin concentrations, HPL OM obtained lower and significantly different values from the HPL AZ group (p < 0.001).When evaluating the concentrations of IL-6, MCP-1, and TNF-α, the group supplemented with papaya seed oil showed lower values and a statistical difference when compared with the HPL OS group , with the same result for microvesicular steatosis (p = 0.005). In ballooning, more cells were identified in the HPL OM group, with a statistical difference in relation to the CT and HPL AZ groups (p = 0.015). There was a lower presence of Mallory hyaline in the HPL OM when compared to CT and HPL AZ (p = 0.030). In the other parameters evaluated in the liver and pancreas, there was no statistical difference between the groups  to serve as a precursor in the synthesis of eicosanoids, thus causing a change in their production. These actions promote the anti-thrombotic effect because of vasodilation and the reduced platelet aggregation [However, omega 3 fatty acids are attributed a greater preventive effect than omega 6 fatty acids . Omega 3regation .The atherogenicity (AI) and thrombogenicity (TI) indices are important tools used to verify the nutritional quality of a product, since these indices indicate the material’s potential to stimulate platelet aggregation; that is, the lower the values of the AI and IT, the greater the amount of anti-atherogenic fatty acids present in a certain oil/fat and, consequently, the greater the potential for preventing the onset of coronary heart disease .n-3 fatty acids, the conversion of linolenic acid into PUFAs is strongly influenced by the levels of linoleic acid in the diet; very high ratios tend to reduce the production of eicosapentanoic acid (EPA), resulting in conditions that facilitate the development of inflammatory and cardiovascular diseases [The omega 6 and omega 3 fatty acids compete for the same enzymes, which are involved in desaturation and chain lengthening reactions. Although these enzymes have greater affinity for the diseases .The results obtained in this current study demonstrate that papaya seed oil has anti-atherogenic effects, as it presents a low atherogenicity index, thrombogenicity index, and ω6:ω3 ratio, which are satisfactory qualities.Even though papaya seed oil has a nutritional quality that guarantees its protective and health-promoting effects, it is important to investigate whether it could be toxic. The present study’s acute toxicity tests proved that the oil did not interfere with food and water consumption, body, and vital organ weights , or behavioral parameters (“Hippocratic screening”) when offered in high doses, according to the OECD protocol (2008) .C. papaya on liver recovery after the use of drugs that induce hepatotoxicity in rodents, with liver recovery occurring and liver damage developing with an increase in antioxidant enzymes, such as superoxide dismutase (SOD), glutathione (GSH), and catalase in the liver, in addition to reductions in the enzymes AST and ALT [Other evidence of papaya seed non-toxicity was found in a study assessing the effects of  and ALT ,28.Similar data on CCl4-induced nephrotoxicity were derived in Wistar rats supplemented with aqueous papaya seed extract, which showed reductions in biochemical parameters such as serum levels of uric acid, urea, and creatinine, in addition to recovery from lesions in histologically evaluated kidneys .C. papaya seed oil presents in its composition important nutrients and bioactive compounds, such as antioxidants, vitamins, and minerals with nutraceutical importance and potential health effects [Given the above, along with the results found in other studies,  effects ,14,16. HChanging the caloric supply triggers possible weight changes and favors the development of metabolic changes ; furtherC. papaya seeds presented in its composition 2.1 g/100 g−1 of fibers and 2.6 g/100 g−1 of proteins [During the experiment, we saw a reduction in feeding in the second month of supplementation; however, a reduction in caloric intake was also noted during the first and second experimental months, as well as in total caloric intake. In addition to the caloric load, the group that received oil from proteins , these bproteins .However, this consumption did not prevent body weight gain, contrary to what was observed in the study by Campuzano-Bublitz et al. (2018) , in whicC. papaya, which may be due to the scientific indications that the nutritional composition of seeds inhibits pancreatic lipase, delaying lipid digestion and consequently the absorption of fatty acids [All the aforementioned studies relate the values obtained in body weight to supplementation with ty acids ,37.In the study by Lee et al. (2018)  of oxidaFurthermore, the study by Od-Ek et al. (2020)  also obtOne of the main effects related to reductions in body weight concomitant with the accumulation of fat, reflected in the percentage of body fat and reductions in the circumference of adipocytes, is the reduction in total cholesterol, LDL-c, and TG levels .The same mechanism may have led to the reductions in total cholesterol, LDL-c, TG, and VLDL-c levels in the present study; this similarity was also found in the study of Zetina et al. (2015) , whereinC. papaya seed oil can reduce the extent of obesity induced by a hypercaloric diet.The studies by Lunagariya et al. (2014) , Manna aThe increase in body weight associated with the accumulation of adipose tissue is an indicator of several metabolic changes, and the storage of adipose tissue in the visceral region results in numerous pathophysiological changes that can favor insulin resistance to different degrees, as well as manifesting increased productions of glucose and reductions in glucose uptake by peripheral tissues, such as muscle tissue ,44.C. papaya oil had a hypoglycemic effect that was also seen in the study by Islam et al. (2019) [p < 0.001). This was also seen in the work of Ezekwe et al. (2017) [C. papaya root for 21 days, which manifested a reduction in fasting hyperglycemia in diabetic animals of 30.95%.In the present study, . (2019) , who pro. (2017) , who indIt was also observed in the present study that, when evaluating the glucose values via the glucose tolerance test (TTOG), no reductions were seen in animals that received papaya seed oil. On the other hand, in the insulin sensitivity test (TSI), the HPL OM group presented values similar to those of CT and AIN-93, both in the assessment of glycemic levels at different times of the test and in the area under the curve, along with a statistical difference in relation to the HPL group, which generated superior results.Carica papaya seeds on the enzymes α-amylase and α-glucosidase. These combat hyperglycemia by inhibiting these enzymes’ digestion and carbohydrate uptake after food ingestion, thus controlling the transport of glucose in the blood, and it was found that all extracts were significantly reduced in postprandial glucose levels, resulting in behavior favorable for TTOG and TSI. It was thus concluded that the inhibition of α-amylase and α-glucosidase enzymes and the prevention of oxidative stress in postprandial hyperglycemia are possible mechanisms by which antidiabetic properties are exerted.Agada et al. (2020)  investigThese changes explain why, in the histological evaluation of the liver, the presence of steatosis and microvesicular steatosis was observed in all groups that received the HPL diet regardless of treatment, as well as an alteration in the cells’ water regulation, which was impaired and caused ballooning or hydropic degeneration, with a greater number of these cells being identified in the HPL OM group. Such changes are common in the context of diets with high levels of carbohydrates and/or lipids, as well as constant changes in blood glucose values that alter the transport and storage of TG in the liver  ,46.Another important aspect relates to the concentrations of hormones such as leptin, which is predominantly (though not exclusively) secreted by adipose tissue ,49. The In a study by Zhao et al. (2020) , it was Resistin, which has the effect of blocking the central action of leptin (the induction of satiety), is a small secretory protein that plays a pleiotropic role in rodents and humans. Furthermore, mouse resistin causes IR and contributes to type 2 diabetes mellitus, while human resistin plays a role in inflammation . Even wiThe study by Od-Ek et al. (2020)  did not Similar to leptin, insulin is a hormone secreted in proportion to fat stores or adipose tissue, through the hypothalamus; it regulates energy expenditure and the mechanisms of hunger and satiety .Insulin is an anabolic hormone manufactured by the pancreas, more specifically by the β cells of the islets of Langerhans, in response to plasma levels of nutrients, especially glucose. It is a polypeptide that acts on lipid metabolism, facilitating the entry of the glucose molecule into the cell interior, interacting with liver, muscle, and adipose tissue cells . InsulinHowever, according to Vugic (2020) , pro-infThese favor insulin resistance, which refers to the inability of the adipose cell to respond to insulin due to the blocking of enzymes and molecules participating in the insulin signaling cascade. This was observed in our study, and even at lower values, it did not differ statistically from the other groups.Metabolic disorders associated with chronic diseases and inflammation were demonstrated by a high concentration of pro-inflammatory markers such as TNF-α, MCP-1 and IL-6, and a decrease in anti-inflammatory factors such as adiponectin. A diet rich in fats has the same effect ,58.Papaya is a good source of antioxidant phytochemicals, such as vitamin C, carotenoids, and vitamin E, which reduce oxidative stress. With reports in the literature of its antioxidant and anti-inflammatory action, the HPL OM group showed a reduction in inflammatory markers  , although not significant, suggesting that with longer treatment this result could be different, as was found by Zetina-Equivel et al. (2015)  and SomaCarica papaya Linn has a fatty acid composition . Studies have shown its antioxidant effect, with high amounts of carotenoids, phenolic compounds, β-carotene, and β-cryptoxanthin, which have anti-inflammatory and antioxidant properties [These results contradict the literature, as the oil obtained from the seeds of operties ,60.Drehmer and collaborators (2019)  have repHowever, these effects of olive oil are only optimized when it is consumed in association with an adequate and balanced diet and physical activity, and when excessive levels of fat are included in the diet, even supplementation with olive oil cannot prevent the onset of obesity, which explains the results of our study in both the HPL OM and HPL AZ groups  Figure .The papayas were obtained from the Supply Center (Ceasa) in the city of Campo Grande, Mato Grosso do Sul, Brazil, between the months of April and August 2018 (SisGen—A38192C). They were deposited in the CGMS/UFMS herbarium with exsiccata number 81021.The oil from papaya seeds was extracted through mechanical cold pressing, according to the methodology of Manzano (2009) . This waThe extracted crude oil was subjected to esterification according to the methodology described by Maia and Rodriguez (1993) . Fatty aTo determine the atherogenicity index (AI) (Equation (1)) and thrombogenicity index (TI) (Equation (2)), we used the expressions proposed by Ulbricht and Southgate (1991) .AI = C1To obtain the ω6:ω3 ratio, the ratio between ω6 concentrations and ω3 concentrations was employed, according to the study by Silva et al. (2018) .o. 980/20178), which is part of the International Guiding Principles for Biomedical Research Involving Animals (CIOMS), Genebra, 1985; the Universal Declaration of Animal Rights (UNESCO), Bruxelles, Belgium, 1978; and the guidelines of the National Health Institutes on the use and care of laboratory animals. The animals were kept under standard laboratory conditions  [The experimental protocol was approved by the Ethics Committee for Animal Use (Protocol nlibitum) . The expn = 5): The control group received saline (1 mL/kg of body wt) and the treatment group received papaya seed oil (5000 mg/kg of body wt), with the same final volume for both groups, administraded as a single dose. After treatment, the animals were observed at 30, 60, 120, 240, 360 min, and then daily for 14 days. The presence of cognitive, neuromuscular, and physical alterations was observed, assigning a zero score to the animals which were normal and graded from 1 to 4 for the changes observed according to the intensity (Hippocratic screening), together with the daily assessment of body weight and food and water consumption. After the toxicity test, the experiment was started [Female Swiss mice (16.6 ± 0.96g of weight) were divided into two groups Swiss mice  were subjected to 7 days of adaptation to the new environment and were later divided into experimental groups as shown in The feed intake was measured weekly, along with the weights of the animals, before the administration of the respective treatments .® and euthanized by exsanguination through the inferior vena cava. Blood samples were centrifuged at 3000 rpm for 5 min, and the serum was separated and stored a −18 °C in a biofreezer for further analysis.After eight weeks of treatment and 8-hour fasting, the animals were anesthetized with IsofluoraneFive sites of adipose tissue were removed ; these were weighed, with subsequent determination of the animal’s fat content (percentage of adipose tissue in each site in relation to body weight) .The liver, pancreas, and epididymal adipose tissue were weighed and fixed in a 10% formalin solution. After 24 h, the tissue was transferred to a 70% ethyl alcohol solution, where it remained until the preparation of the histological slides .®, Brazil.Triglycerides, cholesterol , HDL-c, and blood glucose were measured according to the guidelines of the commercial kit Lab Test Diagnóstica® glucometer . Then, the animals received a D-glucose solution , at 2 g/kg of body weight, by gavage. A blood glucose reading was performed 15, 30, 60, and 120 min after glucose application [The oral glucose tolerance test (OGTT) was performed four days prior to the euthanasia of animals after six hours of fasting. Fasting glucose was verified via flow rate (time 0) using a G-Techlication .® insulin (0.75 U of insulin/kg of body weight), and caudal blood samples were taken at 0, 15, 30, and 60 min after injection. Blood glucose measurements were performed using the G-Tech® glucometer  [After two days, the animals were submitted to the insulin sensitivity test (TSI). The test was performed after the animals were fed, having received an intraperitoneal injection of regular Humulinh Korea) .The blood glucose concentrations were recorded, and from the peak blood glucose values, the area under the curve (AUC) was calculated for each mouse, and the mean was calculated for each experimental group, in terms of both TTOG and TSI ,74.® from Merck. For this purpose, the serum was separated via centrifugation. It was vortexed for 30 s and placed in a centrifuge (5000 rpm for 10 min). Then, 10 µL of serum from each animal was distributed and stored in a 96-well plate, together with 10 µL of Assay buffer solution and 25 µL of solution containing six adipokines. Blank, standard, and control parameters were prepared according to the manufacturer’s instructions . Afterwards, the plate was read on Luminex® by the MAGPIX® software, and concentration values were obtained in µg/mL.The concentrations of adipokines TNF-α, IL-6, MCP-1, insulin, resistin, and leptin were measured using the commercial kit MADKMAG-71KAfter euthanasia, samples of the liver and pancreas were removed for histological study, having been fixed in a 10% formaldehyde solution until embedded in paraffin. Then, 7 µm-thick sections were produced in the microtome, with subsequent mounting on glass slides. For each slide, four cuts were extracted from the paraffin block and stained with HE . The hisFor the analysis of the adipocyte area of the epididymal adipose tissue, images were initially captured using the LEICA DFC 495 digital camera system , integrated with the LEICA DM 5500B microscope  with 20x magnification. The images were analyzed using the LEICA Application Suite software, version 4.0 , and the mean area of 100 adipocytes per sample was determined .The results are expressed as mean ± standard deviation (SD) for parametric data and have been analyzed using Prisma 5.0 software .p ≤ 0.05 were considered statistically significant.Student’s t-test was used for the evaluation between two groups, and for comparisons with more than two groups, analysis of variance (ANOVA) was used to derive parametric data, and Tukey’s post test to derive non-parametric data. Values of Carica papaya Linn seed oil showed a composition predominantly containing monounsaturated fatty acids. The acute toxicity model showed no changes, indicating the safety of its consumption.In our experiment offering a high-fat diet, the group supplemented with papaya seed oil showed hypocholesterolemic, hypotriglyceridemic, and hypoglycemic effects but displayed no significant signs of histopathological protection in the liver and pancreas.No effects were seen in terms of satiety (leptin) and insulin resistance (insulin and resistin), or in inflammatory markers .


Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery  has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies.Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity.The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48  = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group.An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher. One of the most controversial topics in obstetrics in recent years has been the discussion about how to deal with breech delivery, whether vaginal or caesarean. Although caesarean is considered a safe way of treating breech delivery, it contributes to high rates of postpartum maternal morbidity in developed countries and it is known to cause significant complications such as anaemia, urinary tract infections, superficial or complete dehiscence of the operative wound, endometritis, inflammatory complications , muscle However, in 2000, the authors of the Term Breech Trial Collaborative Group (TBT)  publisheSubsequently, in 2006 the PREMODA multicentre study was published . Based oTherefore, the TBT study  was callAnalysing the original TBT data , seriousPrimary caesarean in the first pregnancy has been associated with neonatal and maternal adverse outcomes in subsequent delivery . In thisThe Cochrane review conducted by Hofmeyr et al., which focused on planned caesarean section for term breech delivery, concluded that it reduced perinatal and neonatal death as well as serious neonatal morbidity, at the expense of somewhat increased maternal morbidity compared with planned vaginal delivery. Authors suggested to consider mother's preference for vaginal birth and risks such as future pregnancy complications, and the option of external cephalic version .The meta-analysis conducted by Berhan et al.  , so the results would be a complementary update. The objective of this meta-analysis was to compare the risks of vaginal delivery with elective caesarean in breech presentations, in terms of neonatal mortality, perinatal trauma, Apgar, neonatal intensive care unit (ICU) admittance, and maternal morbidity, according to evidence published during the last 10 years.A systematic review of observational studies and meta-analysis was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed ,14.A systematic bibliographic search was carried out using the Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases. Extensive searches were performed on the reference lists of selected articles. Our search terms included: “breech”, “breech presentation”, “breech birth”, “breech delivery”. During the process, search terms were alternately combined using Boolean logic. The search was based on a clinically answerable question in PICO format, Population ; Intervention ; Comparison (caesarean delivery risks) and Outcomes . Following this structure, the different search strategies were designed. The detailed search strategies employed in each database are summarised in Table S1 in the This revision protocol was registered in PROSPERO.For this study, the default inclusion criteria were:Observational studies of cohorts were included; reviews, brief reports, guidelines, and comments were excluded.Studies that assessed perinatal mortality and morbidity in relation to the type of delivery with breech presentation.Studies published in any language, between January 2010 and September 2020.Studies in which the samples were characterised by full-term gestations (between 37 and 42 weeks of gestation), with a single foetus, and breech presentation.The authors decided to establish observational studies as an inclusion criterion as a review restricted to randomised controlled trials would have given an incomplete summary of the effects of a treatment, due to potential harms. Therefore, ClinicalTrials.gov was not consulted. The studies published before 2010 were excluded because recent scientific publications have turned other previously published ones into outdated evidence, and the aimed was to gather the latest reliable results. In addition, studies where foetuses had lethal congenital abnormalities and caesareans made by other obstetric indications such as multiple pregnancy or intrauterine foetal deaths were also excluded.The selection of studies was carried out in three stages. First, after reviewing the titles, all relevant literature was retrieved from the respective databases. Second, summaries of all recovered articles were reviewed and then grouped as “eligible for inclusion” or “Not eligible for inclusion”. Third, articles that were grouped as “eligible for inclusion” were revised in detail for the final decision.The entire process of selection, the quality assessment and also data extraction were carried out by two investigators independently. Each study was individually evaluated by one of the researchers and results were shared. In case of discrepancies, both researchers discussed their arguments and agreement was reached by consensus; occasionally, a third researcher’s assessment was required.The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. This scale was designed for assessing the quality of non-randomised studies included in a systematic review and/or meta-analyses. It contains eight items organised in three dimensions: the selection of the study groups (four items); the comparability of the groups (one item); and the ascertainment of the outcome (three items). Studies were evaluated following a star system such that each item can be awarded a maximum of one star, excepting the item related to comparability, which allows the assignment of two stars. The total score ranges between zero and nine stars ,16.To structure the collected data, all results compatible with perinatal mortality and morbidity in relation to the type of delivery with breech presentation in full-term gestations (between 37 and 42 weeks of gestation) with a single foetus were searched internationally. The results of the different items were compared on the basis of the primary outcomes, which were neonatal mortality, perinatal trauma, Apgar, neonatal ICU admittance, and maternal morbidity.Data were extracted using a standard Excel  spreadsheet. The extracted data included: the name of the first author, year of publication, period of study, country where the study was conducted in, conclusion of the study, sample size, type of delivery, intrapartum and neonatal mortality, perinatal trauma, Apgar score at the first and fifth minute of life, neonatal ICU admissions, and severe maternal morbidity.In this review, neonatal mortality was considered as deaths before 7 days of age after birth. The WHO establishes early neonatal mortality up to the seventh day of life. Complications at birth as a result of childbirth are manifested in the first 7 days . In factFor this study, severe maternal morbidity was considered as unexpected labour and delivery outcomes that result in significant short-term or long-term consequences for the woman's health. Serious complications of the intervention, whether caesarean or delivery, severe postpartum haemorrhages, neurological problems, sepsis, lung, kidney, or cardiac problems were included .A meta-analysis was performed to evaluate each of the indicators that could measure morbidity and mortality in planned vaginal delivery and scheduled caesarean for breech presentations for both the newborn and the mother.2 test and the I2 values for the following variables:The Mantel-Haenszel method was used to obtain typical RR estimates and 95% confidence intervals (CI). Heterogeneity was determined using the Cochran’s Q χ(1) Early and incipient neonatal death, (2) birth trauma, (3) Apgar test score at 5 minutes, (4) neonatal admission to ICU, (5) severe maternal morbidity.2 and P values. Due to the high I2, an important statistic for assessing heterogeneity, the random effects method was used. The I2 value was interpreted as without heterogeneity (0%), low heterogeneity (<40%), moderate heterogeneity (<60%), substantial heterogeneity (<75%) and considerable heterogeneity (≥75%) [Heterogeneity between studies was assessed by calculating values for Iy (≥75%) . The staThe initial electronic search yielded a total of 19 055 references, and after removing duplicate records, 6802 references were reviewed. Of these, after reading the title and abstract, 6644 references were deleted for not meeting the inclusion criteria, so 158 were selected for full text review. Following the research protocol, 142 were excluded because they were not related to the current revision, because some made comparisons between breech and vertex presentation, and others assessed long-term maternal and neonatal complications. Finally, 16 articles were selected for meta-analysis ,20-34. TOf the 16 studies, 10 had been conducted in Europe, 2 in Asia, 2 in Oceania, and 2 in Africa. Of these, 4 were in favour of elective caesarean to minimise neonatal morbidity but recognised that this increased long-term maternal morbidity by conditioning the type of birth for a future pregnancy ,27,34. TRegarding methodological quality assessment, the included studies were scored from 5 to 9 stars according to de Newcastle-Ottawa scale (2 = 72%). Sensitivity analysis showed that the overall RR was 3.10; 95% CI = 1.8 - 5.2 . As shown in 2 = 70%). The sensitivity analysis showed that the overall RR was 3.6 95% CI = 2.17-6.09.Perinatal trauma analysis included 70 143 single foetus, full-term, breech presentation deliveries . As shown in 2 = 86%). However, the sensitivity analysis showed that the overall RR was 3.8 95% CI = 2.07-7.25.Regarding the Apgar score at minute 5, 13 studies were assessed including 92 135 deliveries with breech, single foetus, and term presentations . 846 (0.92%) neonates of the planned vaginal delivery group had an Apgar below 7 points at the 5th minute of life. Also, in the planned caesarean group, there were 218 (0.24%) neonates whose test score was less than 7 points at 5 minutes of life ,30,32,332 = 64%). However, the sensitivity analysis showed that the overall RR was 1.9 (95% CI = 1.36-2.76).Admittance to neonatal ICU assessment included 9 studies, 32 438 single foetus, full-term, breech presentation deliveries  were included. In the planned vaginal delivery group, there were 435 (1.86%) admittances at the ICU of newborns, while in the planned caesarean group, the figure was 869 (3.72%) ,27,29,302 = 0%).Regarding maternal morbidity, the analysis included 4 studies. 4007 single foetus, full-term, breech presentation deliveries were included  ,27,30,34The meta-analysis has shown a decreased relative risk perinatal mortality and morbidity in a planned caesarean as compared with a vaginal delivery when breech presentation.Regardless of whether childbirth is done vaginally or through caesarean delivery, morbidity and mortality rates have been represented higher at breech births than at cephalic births . Since tAlthough the potential biases associated with the observational design of the studies included in this meta-analysis must be recognised, with the consequent caution in comparing results with similar previous studies, our results were in line with previous meta-analyses. According to Berhan et al. , the relFor the severe maternal morbidity indicator, the present meta-analysis showed a relative risk of 0.30 in favour of vaginal delivery. This means that vaginal delivery is a protective factor against severe maternal morbidity. Although the risk is low, maternal morbidity and mortality increase as a result of complications of a planned caesarean for breech presentations ,36. SeveIn the absence of a contraindication for vaginal delivery, a woman with a breech presentation foetus must be truthfully informed, considering the scientific evidence so far, of the risks and benefits of vaginal breech delivery and elective caesarean, so that the woman can decide and consent to the desired type of delivery ,39. The Regardless of the way of planning the type of delivery, vaginal delivery in breech presentation will always exist, as a delivery may always become urgent and present with these characteristics. Therefore, it is essential that staff attending births do not lose this ability and master it in order to provide quality health care to women .The risks for neonatal mortality and maternal morbidity implies an ethical dilemma: assuming either the risk of neonatal mortality or the risk of severe maternal morbidity. The risk of neonatal mortality was higher; therefore, we would only consider exposing the mother and foetus to vaginal delivery in the case of good obstetric conditions and given that the health care professional is well trained and experienced in these procedures. Otherwise, we recommend delivery by caesarean section. Our study bases the practice of individualisation on decision-making when choosing the type of delivery in unique gestations with full-term foetuses and breech presentation. Each pregnancy should assess the risks individually, considering the woman's preferences and the context, and seeking a balance between neonatal mortality and maternal morbidity.2) in some meta-analyses as, if eliminated, the sample would be drastically reduced.Some limitations have been found in conducting this research, starting with the great variability regarding the size of the samples. Studies with very small samples have had little weight when calculating RR in the grouped meta-analysis, while studies with a very large sample size had much more weight. For this reason, we have had to accept a relatively high (moderate) percentage of heterogeneity (IVaginal, breech, full-term delivery with a single foetus had a higher risk of morbidity and perinatal mortality than caesarean delivery under the same conditions. Still, the results of this meta-analysis suggested that the risk of vaginal breech delivery is lower than in the results of other previously published studies -31,33,34Additionally, the potential bias accompanying observational studies should be acknowledged, given the Newcastle-Ottawa tool identified some items with lack of quality. Therefore, caution is suggested when comparing and generalising the results.Term breech birth risks have been analysed according to two possibilities: Vaginal delivery and caesarean delivery risks. Caesarean had high rates of postpartum maternal morbidity. Also, there is no evidence of reduced child perinatal morbidity or mortality. Otherwise, there is no contraindication for vaginal delivery in breech presentation in selected pregnant women and in the presence of experienced health workers.Our results could help in decision-making related to breech delivery, individualising the decision for each case by knowing the risks associated with each option. From an ethical perspective, the issue addressed in the review is highly sensitive, considering the risk of maternal morbidity and the risk of neonatal mortality. For this reason, further research is suggested that consolidates the available evidence for decision-making between the studied delivery methods.


Increased concentrations of heavy metals in soil due to anthropogenic activities pose a considerable threat to human health and require constant attention. This study investigates the spatial distribution of heavy metals  and metalloids (As) in a typical alluvial–lacustrine transition basin and calculates the bioavailable forms of elements posing a direct threat. Qualitative and quantitative methods were used to identify the sources of contaminants, after which an ecological risk assessment was conducted. Total (T) As, Pb, and Zn decreased with the depth, whereas Cd and Sb increased in surface (0–20 cm) soil. Bioavailable (Bio) Cd and Pb in the topsoil were regulated by pH and organic matter, whereas Bio-Zn was regulated by soil pH. Within deeper soil layers, the combined effects of pH, organic matter, and clay contents regulated the bio-elements. The results of multiple methods and local investigation showed that TSb (65.3%) was mainly derived from mining activities, TCd (53.2%) and TZn (53.7%) were derived from direct pollution by industrial production and agricultural fertilizers, respectively, and TA (55.6%) was mainly derived from the soil parent material. TPb was related to vehicle exhaust emissions and atmospheric deposition from industrial activities. Although the potential ecological risk in the study area remains relatively low, there is a need for continuous monitoring of the potential ecological risks of Cd and Sb. This study can act as a reference for the prevention and mitigation of heavy metal contamination of alluvial–lacustrine transition basins. While soil plays a key role in supporting ecosystems and human development, rapid industrialization and urbanization over the last century has resulted in increasingly serious soil pollution ,2. The sThere have been many studies on the diffusion of heavy metals and specific polluted sites ,6,7,8,9.Heavy metal soil contaminants are characterized by high toxicity, bioaccumulation, and persistence. Long-term soil heavy metal enrichment can lead to a decline in soil buffer capacity and fertility, as well as contamination of crop root growth, thereby reducing crop productivity . The accThe study area is at the entrance of South Dongting Lake, at the junction of the cities of Yiyang and Yueyang . AdminisSoil samples in the study area from the tillage layer and profile were collected by sampling along the Zishui River from Yiyang City toward Dongting Lake. A global positioning system (GPS) was used to determine sampling location information . As show2O2-HCl, purified water, and sodium hexametaphosphate. Soil contents of As, Cd, Pb, Zn, and Sb were extracted in a sequence, during which the water-soluble, ion-exchangeable elements were extracted in sequence. Soil pH was measured using 1:10 carbon dioxide-free water and the ion-selective electrode method (ISE). Soil organic matter content was determined by potassium dichromate redox capacity (VOL). Cd, Pb, and Zn were determined by inductively coupled plasma spectroscopy (ICP-AES). As and Sb were measured by the atomic fluorescence method (AFS). The contents of soil mineral elements  were measured by powder X-ray fluorescence spectrometry (XRF). Soil particle size was assessed using a laser particle size analyzer (LS13-320), during which soil samples were pretreated with Hi is the measured concentration of element i in the sample and Bi is the geochemical background concentration of element i in the Dongting Lake area. PImax is the maximum value of each pollution index in the sample, and PIave is the average value. According to the pollution index (PI) and the Nemerow comprehensive pollution index (NIPI), heavy metal pollution can be divided into five categories: <0.7, 0.7–1, 1–2, 2–3, and ≥3, which represent no pollution, critical threshold, and low, moderate, and heavy pollution, respectively.The single factor pollution index (PI) and the Nemero comprehensive pollution index (NIPI) are commonly used to evaluate the pollution level of each soil sample:geo) was proposed by German scientist Muller (1979) [i is the measured concentration of element i in soil and Bi is the geochemical background concentration of element i in the Dongting Lake area [geo values were classified into seven categories according to Igeo values: <0, 0–1, 1–2, 2–3, 3–4, 4–5, and ≥5, which represent uncontaminated, uncontaminated to moderately contaminated, moderately contaminated, moderately to heavily contaminated, heavily contaminated, heavily to extremely contaminated, and extremely contaminated categories, respectively.The geo-accumulation index (Ir (1979)  to assesr (1979) . The forake area . The Igei is the measured concentration of element i in the soil, Bi is the geochemical background concentration of element i in the Dongting Lake area, Ti is the toxicity response factor, EIi is the single potential ecological risk index, and RI is the potential ecological risk of overall pollution. In this study, the toxicity response factors of As, Cd, Pb, and Zn were 10, 30, 5, and 1, respectively. The EIi indices are divided into five categories: <40, 40–80, 80–160, 160–320, and ≥320, and represent low, moderate, considerable, very high, and hazardous categories, respectively. The RI indices are divided into four categories: <150, 150–300, 300–600, and ≥600, and represent low, moderate, considerable, and very high categories, respectively. Since there is no toxicity response for Sb, the present study did not consider the potential ecological risk index of Sb.The potential ecological risk index (RI) considers four influencing factors: the concentration of heavy metals and metalloids in the soil, the contaminant type, the toxicity, and the sensitivity of the medium to heavy metal contamination. The method was proposed by Hakanson , and theij is the measurement matrix of heavy metal element j in the ith sample, gik is the contribution matrix of factor k in the ith sample, fkj is the source profile of element j in k factors, and eij is the residual value of element j in i samples. By simplifying the objective function Q of the model [ik and fkj are determined and expressed using the following equations.The main sources of heavy metal emissions from soil were resolved by EPA-PMF (version 5.0), a classical model used to assess quantitative source assignments of heavy metals and metalloids, an improved factor decomposition method developed by Paatero and Tapper nearly 30 years ago . It workhe model , gik andij is the uncertainty of metal j on the ith sample, calculated from the detection limit (MDL) of the element-specific method using the following equation.If the heavy metal concentration exceeds the MDL, the uncertainty is calculated as shown below, where uThe concentration data of the five heavy metals and metalloids in the topsoil and the related uncertainty data were input into PMF5.0, and the factor numbers were set to 2, 3, and 4 in the independent model operation with 20 runs. Q was minimized and stabilized at four factors.Spatial distributions of total and bioavailable levels of heavy metals and metalloids were mapped using the ArcGIS 10.3) and Origin 2018 software . SPSS 19.0 software  was used for statistical and correlation analyses of the bioavailable heavy metal soil levels and soil properties. The heavy metal content in the profile soil was mapped using Origin 2018 software. A positive matrix decomposition model (PMF 5.0) evaluated the heavy metal sources.The order of heavy metals and metalloids in topsoil samples according to overall variability was: Sb (143.72%) > Cd (48.09%) > As (26.06%) > Zn (20.82%) > Pb (10.67%), whereas in profile soil samples it was: Sb (101.50%) > Cd (59.41%) > As (37.63%) > Zn 29.23%) > Pb (18.73%). The variability in Sb in the topsoil and profile soil samples exceeded 100%, indicating that Sb may be strongly influenced by anthropogenic activities in the study area [.23% > Pb−1) distributed in the lacustrine sediments, far from the riverbank downstream of the study area. The area around Yiyang, Hunan Province, is rich in mineral resources and has a high concentration of antimony ore and the largest proven and retained reserves in China. This area contains various large and small antimony ore deposits and mining sites [ng sites . Therefong sites . AlthougThe environmental impact of the soil metals and metalloids depends not only on their total concentrations but also on their chemical forms . The sev−1, exceeding the background value by a factor of 0.51. The highest concentration of Sb occurred in XB-P01, downstream of Zishui, which exceeded the background value by a factor of 2.47. The Sb concentration in XB-P01 was significantly higher than those in other profile soil samples, consistent with the distribution of Sb in topsoil. The five heavy metals and metalloids showed different downward migration characteristics. Cd and Sb showed the highest downward migration at a soil depth of 0–20 cm in XB-P01, LX-P01, and LX-P02 and showed clear surface enrichment characteristics, whereas the concentrations of As, Pb, and Zn all decreased with depth. These results indicated that Cd and Sb mainly originated from exogenous inputs, including atmospheric deposition, mining, and other anthropogenic activities at the soil surface. Higher concentrations of Cd and Sb occurred at a soil depth of 60–80 cm in XB-P02, indicating that leaching resulted in deeper migration of Cd and Sb at this site. A previous study found higher concentrations of metals on the surface, which generally decreased with soil depth, and that the vertical distributions of metals were regulated by soil parent material [material . Cd and material . The lowest contents of bioavailable As, Cd, Pb, Zn, and Sb were upstream of the study area, away from the riverbank a–e, show2-Cd and OAC-Cd. An increase in pH results in the hydrolysis of Cd2+ to form precipitated Cd(OH)2 and Cd3(PO4)2, thereby reducing bioavailable Cd [For example, bioavailable Cd in paddy soil generally exists in the form of MgCllable Cd . This lalable Cd . Bioavailable Cd . In addilable Cd  indicate2, Fe2O3, and Na2O. This result further implies that Sb in the topsoil originated from exogenous contamination, which did not extend to the deeper soil layers, whereas bioavailable Sb in deeper soils originated from the soil parent material.Bioavailable Cd and Pb in profile soil were significantly and negatively correlated with pH, similar to the relationship observed in topsoil. Bioavailable Cd also showed a significant positive correlation with clay content. Soil with high clay content is also high in dissolved organic matter, which may facilitate the adsorption of heavy metals and metalloids in soil, resulting in increased concentrations of bioavailable elements . HoweverIn general, the concentrations of bioavailable metals were closely related to soil pH and organic matter content. Soil pH regulates the physical, chemical, and biological processes impacting metal processes in soil, including dissolution, precipitation of metal solid phases, metal complexation, and acid-base reactions . The decThe present study conducted a cluster analysis to identify the sources of soil heavy metals and metalloids in the study area. This involved using a tree graph of the average connection between groups and the application of the systematic clustering method using Pearson’s correlation as the metric standard. Data outliers were eliminated, and the data were standardized before clustering analysis. Therefore, the influences of outliers and specific variables on clustering could be ignored. The distance of the cluster center of 0.2 indicated that As, Cd, Pb, Zn, and Sb in the study area could be divided into four categories : (1) As;2O, Al2O3, and TFe2O3. This result indicated that As and Pb combined with Fe in the soil to form insoluble compounds or co-precipitated with Fe, Al, and other hydroxides. The concentrations of As and Pb were close to the study area background values, and their spatial distributions were significantly different from those of other metals. This implies that PC1 represents natural sources of As and Pb. PC2 showed a strong positive load on Cd, Pb, Zn, Sb, mineral element SiO2, and organic matter, indicating that the heavy metal contents were affected by soil clay and organic matter [As shown in c matter . Soil orc matter . The top2 > 0.9), followed by a high correlation for Cd (r2 = 0.63). These results indicated that the four factors selected as drivers in the PMF model could be regarded as the sources of heavy metals and metalloids in the study area. 7 tons of chemical fertilizers are applied to cultivated soil in China every year [The present study further quantitatively analyzed the sources of heavy metals and metalloids in soil using the PMF model. The PMF model is a source analysis method recommended by the United States Environmental Protection Agency (USEPA). The PMF model has been widely and effectively applied for the quantitative identification of pollutants in air, water, and sediment . The higery year . The lonFactor 2 was the main factor explaining soil Sb (65.3%). Sb is a dominant element in China and is concentrated in 12 antimony-forming belts . The stuFactor 3 was the main factor explaining As (55.6%) and Pb (36.2%). The contents of both these elements in most soil samples were close to the natural background levels. Soil profile analysis showed that there were no significant differences in the concentrations of As and Pb between topsoil and profile soil samples and that they showed low spatial variability. These results imply that parent material and the process of pedogenesis were the main factors affecting the content and distribution of As and Pb in soil. Thus, Factor 3 was defined as the natural soil parent material.Factor 4 was the dominant factor explaining Pb (26.3%) and Cd (13.1%). Atmospheric deposition is usually considered to be an important source of Pb and Cd accumulation in soil . Past stAnthropogenic activities were the main sources of the five elements. Sb (65.3%) was mainly derived from mining activities, Cd (53.2%) and Zn (53.7%) were related to industrial production and application of agricultural fertilizer, and As (55.6%) was mainly derived from the weathering of the soil parent material. Sources of soil Pb included both natural and anthropogenic factors, with the latter including agricultural fertilizer, vehicle emissions, and industrial production.The present study used relevant indices to evaluate the overall risk of heavy metals in the study area based on an understanding of the biological toxicity of heavy metals. The present study applied several methods to evaluate the risk posed by soil metals and metalloids. The results of the Nemerow comprehensive pollution index a,d showeThe geo-accumulation index was calculated using the metal background concentrations for the Dongting Lake basin b,e. The (1)The average concentrations of heavy metals and metalloids in the topsoil and profile soil samples were less than the pollution risk screening values. However, they exceeded the heavy metal background values for the Dongting Lake area. The variability of Sb in the topsoil and profile soil samples exceeded 100%, indicating that soil Sb was strongly regulated by anthropogenic activities in the study area.(2)The bioavailability of Cd and Pb in topsoil was mainly influenced by soil pH and organic matter, whereas that of topsoil Zn was mainly influenced by pH. Soil pH, organic matter, and clay content had a combined effect on bioavailable Cd in the profile soil. pH was the main factor affecting bioavailable Pb, organic matter was the main regulator of bioavailable As and Zn, and soil clay content was the main factor affecting bioavailable Sb.(3)Qualitative and quantitative analyses of the sources of soil metals and metalloids revealed that Sb (65.3%) was mainly derived from mining activities, Cd (53.2%) and Zn (53.7%) were related to industrial production and agricultural fertilization emissions, and As (55.6%) was mainly derived from weathering of the soil parent material. Pb in soil was related to both natural and anthropogenic factors, with the latter including agricultural fertilization, vehicle emissions, and the atmospheric deposition of industrial emissions.(4)There were low soil pollution levels of As, Pb, and Zn in the top and profile soil samples. Heavy metal pollution in topsoil was relatively serious compared to that in the profile soil samples, particularly for Sb; this should receive increasing attention. Although there is a relatively low potential ecological risk in the study area, there is a need for increased attention to the potential ecological risk of Cd in topsoil.


Patients with portal inflammation had a higher risk of progression . High triglycerides levels, advanced fibrosis at baseline and the duration of follow-up predict disease progression . Conclusions: Our results reinforce the evidence that, in the absence of pharmacologic treatment, NASH progresses in about 40% of patients. Liver biopsy is the only mean to discriminate NAFL from NASH. The prognostic role of portal inflammation needs to be explored in larger series.Background and aim: Non-alcoholic fatty liver disease (NAFLD) may progress to severe liver fibrosis and cirrhosis. A limited number of studies with a long follow up assessed fibrosis progression and related predictors in untreated patients with a histological diagnosis of NAFLD. This study aims to investigate rate and predictors of NAFLD progression. Methods: For 9 (2–16.7) years, we followed up a cohort of patients histologically diagnosed. Disease progression was defined by a composite endpoint as evidence of cirrhosis in patients without cirrhosis at baseline, evidence of de novo occurrence of cirrhosis complications, histologically established worsening of stage 1 of fibrosis or increase of 20% in liver stiffness by transient elastography in patients rejecting a second liver biopsy. Results: A total of 91 patients were enrolled. Of them, 31 had NAFL and 60 NASH. A second liver biopsy was performed in 22 NASH patients and in 4 NAFL. Disease progression was observed in 38.5% NASH and in 12.0% NAFL ( Non-alcoholic fatty liver disease (NAFLD) encompasses conditions such as non-alcholic fatty liver (NAFL), non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis, that may require a histopathologic definition. Both a 25% prevalence in the general population, and the rates of NASH-related HCC and liver transplantation, are expected to double by 2030, explaining the growing interest in this condition ,2,3.Liver biopsy allows distinction between NAFL and NASH, and the stages of fibrosis severity and disease activity ,4. Howevp < 0.001), irrespective of NAS score [Several studies investigated the natural history of liver disease in NAFLD; however, the longitudinal assessment of fibrosis progression on multiple biopsies is hardly accepted in the real world and will become even more difficult in the near future, with the approval of experimental drugs under evaluation in phase II and III clinical trials. In a series of 70 patients with paired biopsies, Pais et al. showed that a substantial proportion of subjects progress from NAFL to NASH after 3.4 years . In a meAS score . More reAS score .As fibrosis does not increase linearly, diagnostic, and prognostic relevance of stage 2 diagnosis has been highlighted , making We longitudinally followed up a cohort of Italian patients with histological diagnosis of NASH, with the aim of assessing the proportion of untreated patients who progress over time, and of identifying the predictors of disease progression.Ninety-one patients with a consecutive histological diagnoses of NAFLD, obtained from a larger pool of patients with clinical suspicion from January 2001 to December 2008, and as part of an investigation on abnormal liver enzymes, were included in this longitudinal study . They we2 body mass index (BMI) > 30 both in men and women. A history of systemic hypertension (HBP), defined in accordance with the American College of Cardiology [A diagnosis of diabetes was established based on stable antidiabetic treatment or fasting plasma glucose test results > 126 mg/dL . Hyperlirdiology , was avaLiver biopsy samples were obtained using the modified Menghini technique (Biomol 16 or 18 G). One or two passes were performed. Formalin-fixed, paraffin embedded liver sections were stained routinely with hematoxylin and eosin, and Masson trichrome for collagen. All liver specimens were considered adequate, with a minimum number of portal spaces = 10. They were re-examined in a blind and non-paired manner by an experienced liver pathologist (MG), who was unaware of clinical and biochemical data of patients. An histological diagnosis of NASH was based on accepted criteria ,4 requirDuring the follow up, portal hypertension endoscopic evaluation was performed per BAVENO VI criteria .The variation of PNPLA3  rs738409 on long arm of chromosome 22 was assessed in every patient as described [Patients were followed up with a biannual clinical and biochemical evaluation and underwent TE evaluation and/or liver biopsy during follow up when they failed lifestyle intervention. The mean follow up between baseline biopsy, and last follow up assessment, was 8.81 ± 0.8 years . Only 26 agreed to a second biopsy. Patients on follow up were also evaluated by TE bi-monthly from 2007 (year of Fibroscan availability) to 2021.During follow up, 6 patients with a diagnosis of fibrosis 3 or 4 at baseline developed esophageal varices and 5 died due to stroke or non-liver cancer, with a single case of HCC.The primary endpoint of this longitudinal analysis was disease progression. Disease progression was defined, by a composite endpoint, as evidence of cirrhosis in patients without cirrhosis at baseline, evidence of the de novo occurrence of cirrhosis complications, histologically established worsening of stage 1 of fibrosis or an increase of 20% in liver stiffness by TE in patients rejecting a second liver biopsy.Baseline demographical and clinical characteristics were reported as mean ± standard deviation or median and range for continuous variables, and as frequency and percentages for categorical variables.Group comparisons were carried out using the exact Wilcoxon rank-sum test for continuous variables and Pearson chi-square or Fisher test, as appropriate, for categorical variables.In the basal liver biopsy, in addition to the fibrosis stage and grade of activity, the severity of steatosis and grade, the type  of inflammation and presence or absence of ballooning, were included among the variables examined.As potential predictors of fibrosis, in addition to the histological ones, the following variables were considered: age, gender, diabetes, total and LDL cholesterol, triglycerides, obesity, PLT count, AST, ALT, GGT, and Fib-4 index.Patients were grouped into “progressors” and “non-progressors”. Disease progression was defined as: (i) worsening of at least 1 point on histological fibrosis score; (ii) worsening of liver stiffness results (13); and (iii) occurrence of clinically evident liver cirrhosis or liver related complications as esophageal varices in patients without varices at baseline.An analyses on the potential predictors of progression were performed: (i) on all 91 patients; and (ii) in the sub-group of 26 patients who agreed to a second liver biopsy.p-value < 0.05 was considered statistically significant. All analyses were performed using the SPSS v.15  and the SAS Release 9.4 .A The baseline characteristics of 91 patients followed up for 8.8 years are reported in In the basal liver biopsy, the grade of steatosis was mild in 36.4% of patients, moderate in 31.9%, and severe in 28.6%. According to the SAF score, the grade of activity was 0 in 14.3%, 1 in 47.3% of cases, 2 in 27.2%, and 3 in 11.0%. A portal inflammation of grade 0–1 was detected in 69.3%, and of grade 2 in 19.4% of patients.; a portal inflammation of grade 3, in 11.3%.Basal fibrosis evaluation is reported in Of 91, 9 (9.8%) patients -the majority of whom from the NAFL group—were lost to follow up or moved to another geographic area. Of the remaining 82, including 25 NAFL and 57 NASH, 22 (38.5%) with NASH showed disease progression as compared to three (12.0%) with NAFL. Of the five deaths from the NASH group, only one was liver related. In total, four patients developed endoscopic evidence of portal hypertension and esophageal varices, the remaining 16 had histological evidence of progression, five had evidence of 20% increase in liver stiffness. One of five NAFL patients who agreed to a second liver biopsy showed progression.p = 0.63).As shown in p = 0.018), and activity higher than 1 (p = 0.05), were associated with disease progression by univariate analysis. A numerically higher number of patients with severe lobular inflammation showed progression (p = 0.083). A FIB-4 higher than 2.67 at baseline was predictive of disease progression (p = 0.044).As for histological changes, only fibrosis stage >2, a portal inflammation of grade 3 .The results of the multivariable regression analysis, also including the duration of follow up as an independent variable and adjusting for key demographic factors such as age, gender, and BMI, showed that high triglycerides levels, advanced fibrosis at baseline, and longer duration of follow-up, predict disease progression  in the 26 patients who agreed to it. Histological features in the two paired biopsies are reported in Severe steatosis was present in seven patients (26.9%). Overall, steatosis tended to very marginally increase in severity over the follow up interval. Indeed, in only two out of seven patients with mild steatosis at baseline, a moderate steatosis was observed after the follow up. Activity was mild in 73.0% of cases, moderate in 19.3%, and severe in 7.7% of patients. At the end of follow up, the number of patients with moderate and severe activity substantially increased, as three patients progressed from mild to moderate and two from moderate to severe . The nump = 0.021). As for diabetes, zero out of 13 patients without diabetes, and nine out of 13 with diabetes, experienced histological progression (p = 0.002). Among histological variables, both fibrosis and portal inflammation were associated with the progression of disease . A significantly higher proportion of patients with advanced fibrosis (88.9%) experienced progression, as compared to only three of 17 subjects (17.6%) with stage 0–2 (p = 0.001). Finally, 27.2% of “progressors” had portal inflammation of grade 2–3 as compared to zero of “non-progressors” (p = 0.039). A multivariate analysis was not performed due to the small sample size. We failed to observe any correlation between fibrosis progression and clinical data, with the exception of triglycerides higher than 150 mg/dL. Indeed nine of 11 “progressors” had triglycerides higher than 150 mg/dL as compared to five out of 15 non-progressor (p = 0.27).Among patients who had fibrosis progression, 16 (76.1%) carried PNPLA3 GG, but the rate was not statistically higher when compared to the 93.3% of non-progressors (The results of this large monocentric series of histologically diagnosed NAFLD patients provide evidence that, in Southern Italy, about 40% of patients with NASH diagnosis progress to more severe liver disease, as compared to only 12% of those with simple steatosis, in a median follow-up period of about 9 years. Both rates confirm the progressive nature of this condition ,24,25, wIn addition to a stage of fibrosis 3 or higher, in our series, activity grade and portal inflammation at baseline were both associated with disease worsening. These results suggest that disease evolution is influenced by histological activity. This observation was also confirmed in the setting of repeated liver biopsy; however, probably due to the limited sample size, activity did not result in an independent predictor of disease progression. This finding has great practical relevance. In fact, despite increased portal inflammation being known to be associated with clinical and pathologic features of progressive NAFLD in 728 adults and 205 children , it is nWe suggest that, in selected patients with metabolic syndrome and risk factors for progressive liver disease, a baseline liver biopsy interpreted by a trained liver pathologist, and informative on severity of portal inflammation, provides relevant prognostic information.Interestingly, the progression of fibrosis is a function of the duration of follow up, the longer the follow up duration the higher the risk of progression. In patients with NASH, progression seems to be inevitable. No demographic or biochemical tests, with the only exception of triglycerides, neither non-invasive indexes or stiffness results, were independent predictors of liver disease progression, in our study population. This holds true both in the whole group of patients longitudinally followed and in the subgroup of those with paired biopsies. Diabetes has been identified as predictive of severe fibrosis at diagnosis  and receThe other question is how, and how frequently, our patients should be followed in real life to monitor changes in disease severity. It could be advised that once the presence of fibrosis is identified at baseline by liver biopsy, TE can be used bi-monthly or yearly in patients at risk over time. Indeed, although TE is less accurate in measuring fibrosis in fatty liver than in patients with viral hepatitis , it has Our work is limited by the small sample size and by the fact that only a subgroup of patients agreed to receive a second liver biopsy. The preliminary results of studies on experimental therapeutic compounds suggest that an effective combination treatments will be available for patients with NAFLD in the coming years. In this context, case studies like ours will be impossible to be carried out; these, along with the centralized review of biopsy by the same expert pathologist, are the strength of our data.In conclusion, according to our findings, liver histology remains the reference standard for the assessment of fibrosis progression, not only in clinical studies, but also in clinical practice, although we can expect that non-invasive imaging methods will replace it. The progression of liver disease occurs in 40% of patients with NASH after a median follow-up of almost 9 years, in the absence of any treatment. The independent predictors of progression are triglycerides higher than 150 mg/dL, and advanced fibrosis at baseline histology; however, a numerically higher number of patients with severe inflammation show progression. In waiting for non-invasive diagnostic methods able to assess both fibrosis and activity changes, histology continues to provide unique diagnostic and prognostic insights.


Pelteobagrus fulvidraco-integrated multi-trophic aquaculture system (FMRP). The results showed that the effective trophic level range of FMRP was low (1~2.566), and the energy throughput was mainly concentrated in trophic level I (65.39%). The utilization rate of commercial fish feed was high. Due to the lack of predators for detritus and primary producers (Oryza sativa L. and hydrophyte), the energy throughput of detritus and the primary production were not fully utilized. The ascendency/total development capacity (A/TDC) and overhead/total development capacity (O/TDC) were 0.29 and 0.59, respectively, which indicated that the aquaculture system had high elasticity and strong anti-perturbation ability, but the stability could be substantially improved. The results of the carrying capacity assessment showed that the maximal single increments of Pelteobagrus fulvidraco fry and juvenile were 0.12 g/m2 and 0.42 g/m2, respectively, and the maximal common increments of Pelteobagrus fulvidraco fry and juvenile were 0.10 g/m2 and 0.10 g/m2, respectively, which indicated that there was insufficient space for increment. The study showed that the FMRP still needed to be improved in the aspects of polyculture species, energy consumption and stability. It would be necessary for the FMRP to perform further optimization and enhancement on the energy utilization efficiency, system stability and comprehensive benefits.An integrated multi-trophic aquaculture system (IMTA) combined muti-trophic organism cultivation with ecological engineering facilities effectively improves energy utilization efficiency and reduces pollution emission, which promotes the development of the aquaculture industry. In this study, an Ecopath model was used to analyze the  Pelteobagrus fulvidraco reached 565,477 tons in 2021 [Pelteobagrus fulvidraco aquaculture relies on traditional aquaculture methods, which unilaterally pursues yield with excessive aquaculture density [Pelteobagrus fulvidraco and improve economic and ecological benefits has become the focus and difficulty of Pelteobagrus fulvidraco aquaculture research.As an important freshwater economic fish in China, the output of  density , frequenCyprinus carpio saved 60% of water and reduced emissions by 80% [Cyprinus carpio, Penaeus vannamei and Eriocheir sinensis increased economic and ecological benefits by more than 50% [Eriocheir sinensis larvae, Eriocheir sinensis juvenile and herbivorous fish increased the reuse rates of nitrogen and phosphorus by more than 50% [Pelteobagrus fulvidraco is a new direction to promote industrial upgrading, few studies have been performed.Integrated multi-trophic aquaculture (IMTA) is an aquaculture technology that integrates ecological engineering facilities and ecological engineering systems. It sets up aquaculture facilities according to aquaculture needs and cultivates organisms in different ecological niches, which improves resource utilization efficiency and reduces water pollution . Since 2s by 80% . In the than 50% . ComparePelteobagrus fulvidraco aquaculture system will provide a reference for improvement.In IMTAs, the difference in species and quantity of polyculture organisms is the main factor leading to the difference in aquaculture system functions. Therefore, exploring the nutrient structure and energy characteristics is key to build an efficient IMTA. The Ecopath model is a nutrient balance model, based on the principle of nutrient dynamics, describing energy throughput and the material cycle in the ecosystem . As the Pelteobagrus fulvidraco-integrated multi-trophic aquaculture system (FMRP) was constructed and an Ecopath model was developed. The specific objectives were as follows: (i) to simulate the nutrient structure and energy throughput process of the FMRP; (ii) to analyze the ecological characteristics of the FMRP quantitatively; (iii) to evaluate the carrying capacity of Pelteobagrus fulvidraco preliminarily. It will provide a theoretical basis for optimizing the FMRP and promoting the sustainable development of the Pelteobagrus fulvidraco aquaculture industry.In this study, a Pelteobagrus fulvidraco aquaculture area (FA) and a mixed polyculture area (MA), which were connected by a circulating water system [Pelteobagrus fulvidraco with different specifications to minimize predation. The structure of the FMRP is shown in The experiment was carried out in Songjiang farming base , Fishery Machinery and Instrument Research Institute, Chinese Academy of Fishery Sciences, Shanghai, China. The experiment lasted for 150 days from April 2021 to August 2021. The experimental pond area was 0.48 ha, and the average water depth was 1.4 m. In order to achieve the purpose of polyculture and promote the growth of different organisms, the FMRP separated organisms from different niches by dividing the pond into a r system . In the Pelteobagrus fulvidraco [Pelteobagrusfulvidraco fries were stocked in the FA fry pond with an initial weight of 0.375 g and stocking density of 2.10 ind/m2; Pelteobagrus fulvidraco juveniles were stocked in the juvenile pond with an initial weight of 18.92 g and a stocking density of 0.63 ind/m2; crustaceans, including Macrobrachium nipponense, Procambarus clarkii, Eriocheir sinensis and Bellamya aeruginosa, were stocked in the MA with initial body weights of 1.93 g, 15.66 g, 3.57 g and 2.12 g, respectively, and stocking densities of 1.09 ind/m2, 2.15 ind/m2, 0.21 ind/m2 and 23.16 ind/m2, respectively. In terms of plants, cash crop (Oryza sativa L.) was planted in the MA, with the initial planting density of 10.44 g/m2; hydrophytes were planted in the MA with total initial planting density of 305.28 g/m2, including Ipomoea aquatica Forsk, Hydrocharis dubia (Bl.) Backer, Cyperus invucratus Rottboll and Vallisneria natans (Lour.) Hara.Referring to the species of various trophic levels in the natural habitat of lvidraco ,19,20 anlvidraco , organisDuring the experiment, commercial fish feed containing 40% crude protein, 6% crude fiber and 5% lipid  was provided in the FA at 8:00 a.m. and 17:00 p.m. every day, but no feeding or fertilization was given in the MA. The feeding amount was recorded every day. In order to ensure the healthy growth of stocking organisms, 15~30 fishes, shrimps and crabs were trapped in cages (0.4 m × 0.4 m × 2 m) every 30 days. After the inspection was completed, the sampled organisms were put back into the sampling site.P/B)i represents the ratio of prey production to biomass, Q/B)j is the ratio of predator food consumption to biomass, i to predator j’s total food consumption, i’s bioaccumulation and In the Ecopath model, the ecosystem was divided into related functional groups. According to the principle of energy conservation, a set of simultaneous linear equations was established to balance the energy input and output in each functional group , thus obtaining the static balance model of the ecosystem at a specific time, which could be simplified as :(1)Bi·, production/biomass (P/B), consumption /biomass (Q/B) and diet composition in each functional group. The biomass was expressed as g/m2. The biomass of commercial fish feed was calculated as the average of daily inputs of the 150-day experiment. The biomass of other functional groups was determined by sampling data every 30 days and was expressed as the average of the 150-day experiment.The main input parameters of the Ecopath model included biomass , Pseudorasbora parva, Macrobrachium nipponense, Procambarus clarkii, Eriocheir sinensis, Bellamya aeruginosa and Oryza sativa L. were calculated as the differences between initial and ultimate weight, and the P/B values were calculated using production values and biomass [P/B value was calculated using production values and biomass. The P/B values of hydrophyte [In the aspect of  biomass ,28. Phyt biomass , and thedrophyte , zooplandrophyte  and bactdrophyte  referredQ/B, the Q/B values of Pelteobagrus fulvidraco (fry and juvenile) were calculated using the feeding amount and biomass. The Q/B values of Pseudorasbora parva [Macrobrachium nipponense [Procambarus clarkii [Eriocheir sinensis [Bellamya aeruginosa [In terms of the ra parva , Macrobrpponense , Procamb clarkii , Eriochesinensis , Bellamyruginosa , zooplanruginosa  and bactruginosa  referredPelteobagrus fulvidraco (fry and juvenile) and Pseudorasbora parva were obtained by carbon isotope analysis and referred to the related studies [Macrobrachium nipponense [Procambarus clarkii [Eriocheir sinensis [Bellamya aeruginosa [Diet composition refers to the proportion of each instance of food consumption to total food consumption in a certain organism. The diet compositions of  studies ,33. The pponense ,34,35, P clarkii ,36, Eriosinensis ,33,35,37ruginosa ,33,35,38ruginosa ,35,39 anruginosa  referredP/B, Q/B or food composition to make the output EE within a reasonable range [In the debugging of the model, the ecotrophic efficiency (EE) value (≤1) was the basic limiting condition in each functional group. If EE > 1, this indicated that the biological consumption was higher than the production. In this case, it was necessary to fine-tune the input le range ,40 and ble range .Pelteobagrus fulvidraco based on the Ecopath model. By increasing the biomass continuously (0.02 g/m2 each time) until EE > 1 in any functional group, the biomass of Pelteobagrus fulvidraco reached the carrying capacity [The carrying capacity assessment estimates the maximum biomass limit for certain species in different ecosystems, which is helpful when adjusting the biomass of organisms. In this manuscript, we analyzed the maximum common increment (an increase in both fry and juvenile biomass) and the maximum single increment  of capacity ,30,42.In this manuscript, a variety of parameters were presented to analyze the characteristics of the FMRP based on the Ecopath with Ecosim (v6.5).The transfer efficiency (TE) is calculated as the ratio between the production of a given trophic level and the production of the previous trophic level . The ecoThe total development capacity (TDC) is the product of the flow diversity (diversity of interactions between ecosystem components) and the TST, which is the largest value of ascendency (A) and represents the upper limits of system development . The A iMTI) analysis constructs a matrix to assess the effect that changes in the biomass of a group will have on the biomass of the other groups in an ecosystem [MTI value is calculated as:MTI value, j contributes to the diet of i,j that is due to i as a predator. Results are visualized as black and white dot plots in the Ecopath model to show positive and negative effects.The mixed trophic impact (cosystem . The MTIi), i)  in each functional group according to the energy throughput ratio and integrated trophic level in each functional group, the complex food web relationship in ecosystems can be simplified and the trophic status of each functional group can be displayed intuitively. In the FMRP, the effective trophic levels ranged from 1 to 2.566. level II . EriocheI and II .2·150 days. The TC, TR and TD were 2315.04, 919.21 and 1914.74 g/m2·150 days, accounting for 34.94%, 13.87% and 28.90% of the TST, respectively. Food consumption was the largest component of TST. The TPP and TPP/TR were 2832.87 g/m2·150 days and 3.08, respectively. The TPP was higher than the TR, which indicated that the primary production capacity of FMRP was high. The O/TDC and SOI were 0.59 and 0.11, respectively. The A/TDC and CI were 0.29 and 0.28, respectively. The FCI and FCL were 20.52% and 2.77, respectively. The EPI was 0.78, which was higher than the numerical range of 0.164~0.676 in 393 Ecopath models calculated by Morissett [The analysis of overall characteristics can intuitively reflect the scale, stability and maturity of the ecosystem. The TST of the FMRP was 6626.25 g/mPelteobagrus fulvidraco (fry and juvenile) were 4.37% and 2.53%, respectively, accounting for 6.80% in total. The energy throughput consumption ratios of other species  accounted for 50.22% in total. The energy throughput consumption ratio of zooplankton  accounted for 7.69% in total. The results showed that the energy throughput consumption of Pelteobagrus fulvidraco was low  flowed into trophic level II; the rest was not utilized and instead accumulated at the bottom of the pond.  and Pseudorasbora parva. Phytoplankton could promote crustaceans . This result indicated that commercial fish feed and phytoplankton played an important role in the food sources. Pseudorasbora parva had an inhibitory effect on Pelteobagrus fulvidraco (fry and juvenile), indicating a competitive relationship. Bacteria had a strong inhibitory effect on detritus, suggesting that bacteria depended on detritus as food source. Bellamya aeruginosa had a strong inhibitory effect on phytoplankton and bacteria. The feeding effect was obvious (The mixed trophic impact (MTI) analysis is an effective way to analyze the direct and indirect interaction between different populations in an ecosystem . All con obvious .Oryza sativa L. were −2.11, −1.03 and −1.00, respectively, showing light influences on the ecosystem  was higher than that in traditional aquaculture systems (23.90%) , indicatPelteobagrus fulvidraco (fry and juvenile)  was lower than that of other polyculture organisms  , which might be related to the small culture scale of Pelteobagrus fulvidraco and the unreasonable biomass ratio with other polyculture organisms. In addition, the mixed trophic impact analysis showed that Pseudorasbora parva had an inhibitory effect on Pelteobagrus fulvidraco, except for the density restriction effect inside Pelteobagrus fulvidraco. This might be conducive to the growth of Pelteobagrus fulvidraco due to the competitive relationship. In terms of system energy utilization, fishing or predation pressure might be the reason for high EE values (>0.8) of Pelteobagrus fulvidraco (juvenile and fry), Oryza sativa L., zooplankton (Copepoda and Cladocera) and commercial fish feed in the FMRP. Commercial fish feed was fully utilized. As an important food source and keystone species, phytoplankton was fed upon by zooplankton, Pseudorasbora parva and Macrobrachium nipponense, which had a high EE value (0.93). It was speculated that the bottom-up effect was obvious [2·150 days) with an EE value of 0.12. There was only Bellamya aeruginosa that had an obvious predation effect on bacteria. This might be because detritus energy hardly transfers to a higher trophic level, thus, impeding the detritus energy cycle [Compared with the traditional monoculture system, IMTAs have higher energy utilization efficiency, lower accumulation of nitrogen and phosphorus nutrients, and diversified and stable farming income. However, allocating more energy to maintain the system structure usually results in a decrease in the bioaccumulation of target farming organisms, which contradicts the goal of obtaining a high yield ,58. In t obvious . The abs obvious ,35, the gy cycle .Pelteobagrus fulvidraco aquaculture systems. However, a comparison of system characteristic parameters of the FMRP with those of other IMTAs with a similar function and structure is useful in assessing the relative performance of the FMRP. The TST (6626.25 g/m2·150 days), TP (3567.19 g/m2·150 days) and TPP (2832.87 g/m2 150 days) values of FMRP were lower than those in the rice–carp IMTA, the rice–crab IMTA and the rice–crayfish IMTA [In this study, we constructed a FMRP prototype, which had a relatively complete ecological structure and diversified farming income due to planting cash crops, hydrophytes and cultivating muti-trophic organisms. At present, there were few similar ish IMTA  (Figure ish IMTA  and the ish IMTA , indicatish IMTA . It may Pelteobagrus fulvidraco aquaculture, the stocking amount of Pelteobagrus fulvidraco should be increased and the collocation of polyculture organisms should be optimized. The results of the carrying capacity assessment showed that there was insufficient increment space for Pelteobagrus fulvidraco, which might be related to the low feeding level and competition between Pelteobagrus fulvidraco and wild fishes. Thus, the feeding level should be increased, and wild fishes should be removed in time to prevent feeding competition. Based on this, the energy consumption ratio of Pelteobagrus fulvidraco will probably increase through raising Pelteobagrus fulvidraco and reducing other polyculture species appropriately for more farming income. It may be useful to reduce the water exchange rate in the FMRP to provide abundant food sources for polyculture organisms by increasing phytoplankton biomass [In order to improve the energy utilization rate and increase the income of  biomass . In viewPelteobagrus fulvidraco. Optimizing polyculture collocation, adjusting the feeding strategy and improving aquaculture management would be effective for structure improvement, stability enhancement and increasing of benefits.This study clarified the characteristics of energy flow and trophic structure in the FMRP. The results showed that the FMRP had high commercial fish feed utilization efficiency, transfer efficiency and anti-perturbation ability, which was beneficial to the aquaculture activities. However, the small culture scale and simple trophic structure caused many problems, such as the insufficient utilization of detritus, primary production energy and low energy consumption ratio of Pelteobagrus fulvidraco aquaculture.In an effort to fully implement green ecological aquaculture, the Ecopath technique can provide theoretical guidance for the transformation and upgrading of