Exosomes are extracellular vesicles released from various cellular sources and are widely present in body fluids. Bioactive substances such as microRNAs, mRNAs, and proteins are encapsulated in exosomes, which can activate various signaling pathways and play important roles in early warning of stroke and neurovascular unit repair. This article reviews the signal transduction of exosomes in cerebral ischemia.

Mesenchymal stem cells are a kind of pluripotent stem cells that play a role in stroke treatment mainly through paracrine mechanisms. Recent studies have shown that mesenchymal stem cell-derived exosomes play an important role in reducing post-stroke injury, promoting neural repair and angiogenesis. This article describes the research progress of bone marrow mesenchymal stem cell-derived exosomes in the treatment of stroke, and investigates the therapeutic mechanism and application prospects of exosomes bioactive substances represented by microRNAs.

Micro RNAs are a kind of conserved short non-coding RNAs that regulate life activities at molecular level. Micro RNAs are active in various stages of autophagy after ischemic stroke; micro RNAs play protective or destructive roles in autophagy after stroke. Based on the autophagy process, we discuss the possible mechanism of autophagy regulated by micro RNAs through autophagy related genes or pathways, and analyze the application prospect of micro RNAs in stroke diagnosis and treatment.

Objective:To observe the effect of paeoniflorin on motor behavior and dopamine neurons of mice with Parkinson's disease (PD) by activating autophagy.Methods:Forty C57BL/6 mice were randomly divided into normal control group, model group, paeoniflorin group and paeoniflorin+3-methyl adenine (3-MA) group ( n=10). The later 3 groups were intraperitoneally injected with 1-methyl-4-phenyl-1,2,3,6-tetmhydropyridine (MPTP) at a dosage of 30 mg/(kg·d) for a consecutive 7 d to establish subacute PD models. Meanwhile, mice in the paeoniflorin group and paeoniflorin+3-MA group were intraperitoneally injected with paeoniflorin (30 mg/[kg·d]) or paeoniflorin (30 mg/[kg·d])+3-MA (2 mg/[kg·d]), respectively. Eight d after modeling, pole test and traction test were used to evaluate the locomotor ability of mice in each group. Then, the substantia nigra of the midbrain was taken; TUNEL was used to detect the nerve cell apoptosis; immunohistochemical staining was used to detect the number of tyrosine hydroxylase (TH) positive cells and the expressions of α-synuclein (α-Syn), lysosomal associated membrane protein 2A (LAMP2A) and microtubule-associated protein 1 light chain 3-II (LC3-II); Western blotting was used to detect the LAMP2A and LC3-II protein levels. Results:As compared with model group, paeoniflorin group had significantly shortened rod climbing time, significantly higher scores in traction test, significantly decreased number of apoptotic nerve cells, significantly increased number of TH-positive cells and expressions of LAMP2A and LC3-II, significantly decreased α-Syn expression, and significantly increased protein levels of LAMP2A and LC3-II ( P<0.05). The paeoniflorin+3-MA group had significantly prolonged rod climbing time, significantly lower scores in traction test, significantly increased number of apoptotic nerve cells, significantly decreased number of TH-positive cells and expressions of LAMP2A and LC3-II, significantly increased expression of α-Syn, and significantly decreased protein levels of LAMP2A and LC3-II as compared with the paeoniflorin group ( P<0.05). Conclusion:Paeoniflorin can improve dyskinesia in PD mice by inducing autophagy to remove α-Syn and protect dopaminergic neurons.

BACKGROUND:The distribution of horizontal pressure in adolescent idiopathic scoliosis can be used to evaluate the coronal imbalance.Currently,there are no reports on the characteristics of coronal pressure distribution and its correlation with coronal imbalance. OBJECTIVE:To explore the correlation between coronal pressure variation and coronal imbalance in adolescent idiopathic scoliosis patients. METHODS:A total of 39 adolescent idiopathic scoliosis patients who met the inclusion and exclusion criteria in Lianyungang First People's Hospital from March 2021 to June 2022 were selected as the adolescent idiopathic scoliosis group,and 30 matched healthy volunteers were recruited from the outpatient department as the control group.The horizontal position pressure,folding position pressure,coefficient of variation,and global and trunk pressure variation were measured by the TBED Postural Couch evaluation system.In the adolescent idiopathic scoliosis group,full-length spine radiographs were taken to measure Cobb angle,coronal balance,apical vertebral deviation and Nash-Moe rotation.The characteristics of coronal pressure variation and its correlation with coronal imbalance were analyzed. RESULTS AND CONCLUSION:(1)Compared with the control group,there was no statistically significant difference in the horizontal position pressure and folding position pressure in the adolescent idiopathic scoliosis group(P>0.05),but the global pressure variation and coefficient of variation were significantly increased(all P<0.05).(2)There were differences in both sides of the trunk of the adolescent idiopathic scoliosis group and the control group(P<0.05),and the convex side pressure variation in the adolescent idiopathic scoliosis group was higher than the concave side pressure variation in the left and right side pressure variation in the control group(all P<0.05).(3)The variation of the convex side pressure of the trunk in adolescent idiopathic scoliosis patients was positively correlated with coronal balance intensity(r=0.692,P<0.05),moderately positively correlated with Cobb angle and apical vertebral deviation(r=0.499,0.595,all P<0.05),and weakly correlated with Nash-Moe grade(r=0.377,P<0.05).The variation of the concave side pressure of the trunk was moderately positively correlated with coronal balance(r=0.410,P<0.05),and the rest was weakly correlated or not correlated(P>0.05).(4)These findings indicate that pressure variation may be used as an adjoint assessment tool in patients with mild to moderate scoliosis.

Objective:To explore the effect of Baduanjin on gait parameters and serum nerve growth factor in Parkinson disease (PD) patients with freezing of gait(FOG).Methods:From December 2021 to December 2022, thirty-eight PD patients with FOG who met the inclusion and exclusion criteria were randomly divided into observation group ( n=18) and control group ( n=20) by random number table.The patients in both two groups received 4 weeks of drug therapy combined with basic rehabilitation treatment respectively, and the patients in observation group received additional Baduanjin training.Efficacy was evaluated 1 day before intervention and after 4 weeks of intervention through unified Parkinson's disease rating scale-Ⅱ(UPDRS-Ⅱ) item 14, freezing of gait questionnaire (FOGQ), gait starting time, gait cycle, stride length, dynamic plantar peak pressure and average pressure, while the levels of brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor(GDNF) in peripheral blood of patients were tested.SPSS 23.0 software was used to conduct Chi-square test, paired t-test, independent sample t-test and Mann-Whitney U test. Results:Before treatment, there were no significant differences in score of UPDRS-Ⅱ item 14, FOGQ score, gait starting time, gait cycle, stride length, dynamic planar peak pressure, average pressure, peripheral blood BDNF level and GDNF level between the two groups ( t=-0.542, 0.562, 0.490, 0.674, 0.440, 0.606, -0.835, -0.873, -0.250, all P>0.05). After treatment, compared with the control group, dynamic plantar peak pressure (control group (14.26±3.23) N/cm 2, observation group (11.40±4.13) N/cm 2, t=-2.389, P=0.022) and plantar average pressure (control group (3.34±0.72) N/cm 2, observation group (2.79±0.81) N/cm 2, t=-2.209, P=0.034) of the observation group were significantly decreased (both P<0.05). There were no significant differences in UPDRS-Ⅱ item 14, FOGQ score, gait starting time, gait cycle, stride length, BDNF and GDNF concentrations in peripheral blood between the two groups after treatment (all P>0.05). The difference between pre-treatment and post-treatment of FOGQ score (control group 1.00 (0.00, 1.00) , observation group 2.00 (0.75, 3.00), Z=-2.547, P=0.011), gait starting time (control group -1.04 (-1.86, -0.47)s, observation group -2.34 (-3.41, -1.03) s, Z=-2.280, P=0.023), gait cycle (control group 0.29 (0.08, 0.58)s, observation group 0.35 (0.16, 1.00) s, Z=-2.748, P=0.006), stride length(control group 0.19 (0.14, 0.24) m, observation group 0.26 (0.23, 0.38)m, Z=-1.360, P=0.005), the dynamic plantar peak pressure (control group -4.11 (-5.87, -2.57) N/cm 2, observation group -8.44 (-10.12, -4.81) N/cm 2, Z=-3.333, P=0.001) and average pressure (control group -0.55 (-1.00, -0.03) N/cm 2, observation group -1.11 (-1.51, -0.66) N/cm 2, Z=-2.062, P=0.009) in the observation group were better than those in the control group.After treatment, the BDNF level in peripheral blood in observation group was higher than before treatment( t=-2.315, P=0.033). Conclusion:Baduanjin can improve frozen gait score and gait parameters in PD patients with FOG, which may be related to the increase of peripheral blood BDNF.

Objective:To investigate the effectiveness and safety of fully-covered self-expandable metal stent (FCSEMS) with plastic stent over the treatment of post liver transplantation anastomotic biliary stricture (AS).Methods:The clinical data of AS patients after liver transplantation admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2014 to April 2018 was collected for the retrospective study. According to different implanted stents, patients were divided into FCSEMS group and plastic stent group. The general information of the two groups of patients, surgical success rate, postoperative complications, the number of endoscopic retrograde cholangiopancreatography (ERCP), the number of indwelling stents and other indicators were compared and analyzed.Results:A total of 54 patients were enrolled, including 41 males and 13 females, with a median age of 48 (34-65) years. A total of 23 cases were included in the FCSEMS group and 31 cases were included in the plastic stent group. The overall technical success rate of the operation was 98.3% (176/179). In the FCSEMS group, there were 21 patients recovered and 2 patients were relieved; in the plastic stent group, 29 patients were recovered, 1 case was relieved, and 1 case failed. There were no statistically significant differences in the efficacy and complication rate between the two groups (all P>0.05). The median stent indwelling time, ERCP times, and the number of indwelling stents in the FCSEMS group were 5.9 months, 2 times, and 1, respectively, and in the plastic stent group were 9.5 months, 4 times, and 8 respectively. There were statistical differences between the two groups (all P<0.05). Conclusions:FCSEMS for treatment of AS showed less duration of stenting, numbers of stents and endoscopic treatment sessions with the similar efficacy as plastic stents. It’s indicated that it’s necessary to pay attention to the probability of stent migration and pancreatitis.

OBJECTIVE To investigate the effects of Taohong siwu decoction modified granules on podocyte epithelial- mesenchymal-transition （EMT） and renal fibrosis in diabetic kidney disease （DKD） model rats. METHODS Eight rats were selected as normal group （ordinary feed）； the remaining rats were given a high-glucose and high-fat diet combined with intraperitoneal injection of streptozotocin （35 mg/kg） to induce the DKD model. Model rats were randomly divided into model group， irbesartan group [positive control， 13.5 mg/（kg·d）] and modified Taohong siwu decoction group [6.48 g/（kg·d）]， with 8 rats in each group. All groups were given relevant medicine intragastrically， once a day， for 16 consecutive weeks. Twenty-four- hour urinary total protein （24 h UTP） was detected at the end of the 4th， 8th， 12th and 16th week of administration. After the last medication， the body mass， water intake， food intake， urine output， the levels of fasting blood glucose， serum creatinine （Scr） and blood urea nitrogen （BUN） as well as mRNA and protein expressions of P-cadherin， nephrin， α -smooth muscle actin （α-SMA）， Wilms’ tumor gene 1 （WT1）， transforming growth factor-β1（ TGF-β1） and type Ⅳ collagen （Col-Ⅳ） in renal tissue were determined. The pathological and morphological changes in renal tissue were observed and the thickness of the glomerular basement membrane was determined. RESULTS Compared with the model group， 24 h UTP of rats was significantly decreased in modified Taohong siwu decoction group since the 8th weekend （P＜0.05）； the body weight of rats increased significantly， but the amount of water intake and urine decreased significantly； Scr and BUN level， mRNA expression of α-SMA， mRNA and protein expressions of TGF-β1 and Col-Ⅳ were significantly reduced， while the mRNA expressions of P-cadherin， nephrin and WT1 were increased significantly （P＜0.05）； the protein deposition of α-SMA was reduced， protein depositions of P-cadherin， nephrin and WT1 were increased； the pathological damage and fibrosis of renal tissue were relieved； the thickness of glomerular basement membrane was decreased significantly （P＜0.05）. CONCLUSIONS Taohong siwu decoction modified granules can inhibit the EMT of podocyte in DKD model rats， and alleviate renal pathological damage and podocyte damage， thus protecting renal function， and delaying the process of renal fibrosis.

OBJECTIVE To investigate the effects of Taohong siwu decoction modified granules on podocyte epithelial- mesenchymal-transition （EMT） and renal fibrosis in diabetic kidney disease （DKD） model rats. METHODS Eight rats were selected as normal group （ordinary feed）； the remaining rats were given a high-glucose and high-fat diet combined with intraperitoneal injection of streptozotocin （35 mg/kg） to induce the DKD model. Model rats were randomly divided into model group， irbesartan group [positive control， 13.5 mg/（kg·d）] and modified Taohong siwu decoction group [6.48 g/（kg·d）]， with 8 rats in each group. All groups were given relevant medicine intragastrically， once a day， for 16 consecutive weeks. Twenty-four- hour urinary total protein （24 h UTP） was detected at the end of the 4th， 8th， 12th and 16th week of administration. After the last medication， the body mass， water intake， food intake， urine output， the levels of fasting blood glucose， serum creatinine （Scr） and blood urea nitrogen （BUN） as well as mRNA and protein expressions of P-cadherin， nephrin， α -smooth muscle actin （α-SMA）， Wilms’ tumor gene 1 （WT1）， transforming growth factor-β1（ TGF-β1） and type Ⅳ collagen （Col-Ⅳ） in renal tissue were determined. The pathological and morphological changes in renal tissue were observed and the thickness of the glomerular basement membrane was determined. RESULTS Compared with the model group， 24 h UTP of rats was significantly decreased in modified Taohong siwu decoction group since the 8th weekend （P＜0.05）； the body weight of rats increased significantly， but the amount of water intake and urine decreased significantly； Scr and BUN level， mRNA expression of α-SMA， mRNA and protein expressions of TGF-β1 and Col-Ⅳ were significantly reduced， while the mRNA expressions of P-cadherin， nephrin and WT1 were increased significantly （P＜0.05）； the protein deposition of α-SMA was reduced， protein depositions of P-cadherin， nephrin and WT1 were increased； the pathological damage and fibrosis of renal tissue were relieved； the thickness of glomerular basement membrane was decreased significantly （P＜0.05）. CONCLUSIONS Taohong siwu decoction modified granules can inhibit the EMT of podocyte in DKD model rats， and alleviate renal pathological damage and podocyte damage， thus protecting renal function， and delaying the process of renal fibrosis.