Objective To evaluate the curative effect of acupuncture combined with conventional therapy for the treatment of post-stroke depression (PSD). Methods Sixty patients were divided into two groups according to the computer. Acupuncture group was treated with acupuncture combined with conventional therapy of western medicine. Non-acupuncture group was treated with sham acupuncture combined with conventional therapy. Both groups were treated for 4 weeks. The patients was evaluated using the Hamilton depression rating for scale (HAMD). Adverse reactions during treatment were assessed by the Treatment emergent Symptom Scale (TESS). Results The HAMD score at the first week (27.1 ± 6.1 vs. 30.8 ±5.0,t=-5.532),the second week(26.6 ±6.3 vs.15.8 ±7.3,t=2.744),the 4th week(15.8 ±7.3 vs.20.7 ± 5.2,t=3.570),and the 8th week(9.9 ±6.2 vs.15.6 ±5.7,t=6.154)in the acupuncture group were lower than those in the non-acupuncture group (P<0.01). During the treatment, 2 cases of insommia occurred in acupuncture group, 8 cases of insommia occurred in nonacupuncture group, 2 cases of nausea and vomiting occurred in acupuncture group, 9 cases of nausea and vomiting occurred in nonacupuncture group(χ2=10.550, P=0.001).Conclusions Acupuncture combined with conventional therapy can improve the depressive state of PSD patients, reduce the adverse reactions and improve the quality of life of patients.

Objective : To analyze the status and influencing factors of the intention of people aged 18 to 25 years to primary medical institutions and their satisfaction for health services in Zhejiang Province, so as to provide basis for the improvement of health services in primary medical institutions. Methods: During November and December in 2019,the 18-25 year-old people in Zhejiang Province were recruited to investigate the general information, intention to seek medical advice and satisfaction for health services in primary medical institutions through WeChat. Logistic regression was performed to analyze the influencing factors of the intention and the satisfaction. Importance matrix was used to analyze the key drivers of the satisfaction. Results: Among the 620 people surveyed, with a response rate of 93.37%, 142 (22.90%) chose primary medical institutions for advice. Actually 516 (83.23%) people went to primary medical institutions last year, and 384 ( 74.42% ) of them were satisfied with the health services. The results of multivariate logistic regression analysis showed that the people aged 18-25 years who were under the new rural cooperative medical care system ( OR=3.062, 95%CI: 1.745-5.373 ) and who had records in community health centers ( OR=0.547, 95%CI: 0.308-0.970 ) were more likely to go to primary medical institutions for medical advice; the ability of doctors ( OR=1.478, 95%CI:1.168-1.871 ) ,the drug notification by medical staff ( OR=1.308, 95%CI: 1.065-1.606 ) , routine examination items ( OR=1.523, 95%CI: 1.227-1.889 ) , the ways of payment ( OR=1.168, 95%CI: 1.017-1.340 ) , the comfort of environment ( OR=1.785, 95%CI: 1.437-2.219 ) and the bulletin boards of health knowledge ( OR=1.302, 95%CI: 1.086-1.561 ) were associated with the satisfaction. The results of importance matrix analysis showed that the ability of doctors and routine examination items were the priorities to improve, followed by the drug notification by medical staff; the comfort of environment had competitive advantages; the ways of payment and the bulletin boards of health knowledge needed to be further analyzed. Conclusions The 18-25-year-old people in Zhejiang Province were less intended to seek medical advice in primary medical institutions, which was associated with the type of medical insurance and records in community health centers. They were satisfied with the health services, the ability of doctors and routine examination items were the key drivers.

ObjectiveTo analyze the psychological resilience characteristics of visually impaired adolescents. MethodsFrom February to May, 2023, 13 visually impaired adolescents (average age of 16.5 years) from Nanjing Normal University of Special Education, Yangzhou Special Education School and Nanjing School for the Blind in Jiangsu, China were selected for semi-structured interviews with phenomenological method, and the interview data were sorted by theme analysis method. ResultsFour themes and twelve sub-themes were obtained; namely multiple sources of difficulties, including travel difficulties, learning difficulties, social difficulties and difficulties in daily life; need for external support, including insufficient family support, school support needs to be improved, need for peer support and insufficient social support; negative and positive adaptation coexist, including negative adaptation and positive adaptation; and negative coping and positive coping coexist, including positive coping and negative coping. ConclusionThe psychological resilience of visually impaired adolescents is characterized by multiple sources of difficulties, insufficient external support, coexistence of positive and negative adaptation, and coexistence of positive and negative coping. A joint family-school-society support system should be formed to reduce the source of their difficulties, and help them establish positive adaptation and positive coping methods, to enhance their psychological resilience.

【Objective】 To investigate the effects of neutrophil-derived exosomes on skin wound healing. 【Method】 ① The venous blood was taken from 10 healthy volunteers to separate and purify neutrophils, and exosomes were prepared from neutrophil supernatants using differential centrifugation on Sepharose columns. ② The rat trauma model with full-thickness skin defect was prepared and randomly divided into three groups: control group, 50 μg/mL exosomes group, and 100 μg/mL exosomes group. The CCK8 test and the scratch test were used to determine the proliferation and migration of vascular endothelial cells, respectively, which was used to investigate the effects of neutrophil-derived exosomes on the formation of endothelial cell tubular structures in vitro. On day 7 and day 14 after surgery, the skin wound healing was observed and the wound healing rate in different treatment groups was compared. On day 14 after surgery, the wound tissues of each group were stained with HE and Masson to observe the arrangement of collagen fibers. 【Results】 ① Neutrophil-derived exosomes were round or oval vesicles with diameter about 100 nm. ② On post injury hour (PIH) 12, the scratch test suggested that wound healing rates in the three groups were close (P>0.05 ), while wound healing rate of 100 μg/mL neutrophil-derived exosomes in the treatment group was higher than that in the control group (P<0.01) and 50 μg/mL exosomes group (P<0.05) on PIH 24. On PIH 12, the result of CCK8 assay showed that 50 and 100 μg/mL exosomes groups had enhanced proliferative activity of vascular endothelial cells (P<0.01) and the results were still higher in both groups than in the control group on PID 24. The results of tube formation assay showed that neutrophil-derived exosomes could promote the formation of tubular structures of endothelial cells in vitro (P<0.01). ③ On day 7 and 14 after surgery, compared with the control group, the wound healing rates of the 50 and 100 μg/mL exosomes groups were higher (P<0.01). The wound healing rate of 100 μg/mL exosomes group was higher than that of 50 μg/mL exosomes group (P<0.01). Compared with the control group, the newly formed epidermis and dermis on the wound surface of the 100 μg/mL exosomes group were longer, the number of collagen fibers increased, and the arrangement direction was highly consistent on the 14 th day after surgery. 【Conclusions】 Neutrophil-derived exosomes can promote full-thickness wound healing in rats by promoting the proliferation and migration of new vascular endothelial cells and the formation of collagen fibrous.

【Objective】 To determine the rare ABO blood subgroups rapidly and ensure the blood transfusion safety of five patients by a series of serological tests and family investigation, as their preliminary serological results of ABO blood grouping was inconsistent. 【Methods】 ABO blood grouping, antibody screening and Coombs′ tests were performed by the routine serological methods, including manual tube and automatic blood group analyzer, which had matched micro-column gel cards from Diagnostic Grifols. Polymerase chain reaction (PCR) was used to amplify the 6 and 7 exons as well as their adjacent intron region of ABO gene. The patients and their relatives′ ABO blood group and subgroup were analyzed and identified through the comparison with serological phenotype database of ABO blood group. The products of PCR were sequenced directly, and the gene mutation was identified through the comparison with the Blood Group Antigen Gene Mutation Database. 【Results】 Whether micro-column gel cards or manual tube test, the forward and reverse tests of serological grouping were not supported by each other on the five patients′ ABO blood grouping. The forward tests of patients No.1~3 showed AwB phenotype and the reverse tests showed B group. No.4 patient was the forward ABw phenotype and the reverse A group, and No.5 patient was the forward normal AB phenotype and the reverse B group, respectively. All of 5 patients′ Rh C/D/E blood grouping showed clearly; the IDT test and antibody screening result of patient No.1 was positive, while the antibody screening result of patient No.4 was negative. 【Conclusion】 The blood group serological characterization of patient No.1~3 met B(A) blood group, and patient No.4~5 met CisAB blood group. These tests can make a preliminary diagnosis of blood group phenotype, which are verified correctly via blood group genotype.

This study aimed at conducting retrospective analysis of the clinical symptoms and genetic mutations in 20 children with Gitelman syndrome treated at the Affiliated Children′s Hospital of Nanjing Medical University from August 2015 to November 2022 and also explored the molecular mechanism of the pathogenic high-frequency mutation D486N in the Chinese population.

Objective : To analyze the length of hospital stay of patients with heart failure in a multicenter cohort in order to explore the influencing factors of length of stay and provide data support for further intervention. Methods: A total of 2 794 patients enrolled in the multicenter prospective heart failure cohort were divided into two groups: long hospital stay group (≥9 days) and short hospital stay group ( < 9 days) . The general data of the two groups were compared, and the factors with statistical difference in univariate analysis were included in Logistic multifactor regression analysis to explore the difference in length of hospital stay between the two groups. According to left ventricular ejection fraction(LVEF), patients were divided into heart failure with preserved reduced ejection fraction (HFpEF)group, heart failure with mildly reduced ejection fraction(HFmrEF)group and heart failure with reduced ejection fraction(HFrEF) group, and Logistic multifactor regression analysis was performed to find influencing factors. Results : Logistic multifactor regression analysis showed that LVEF, pneumonia, N⁃terminal pro⁃B⁃type natriuretic peptide(NT⁃proBNP), serum sodium, cardiac resynchronization therapy( CRT) or implantable cardioverter defibrillator(ICD)implantation, β blockers, aldosterone receptor antagonists, positive inotropic drugs and vasodilators were all factors influencing the hospitalization of HF patients. In the HFpEF, HFmrEF, and HFrEF groupsCRT/ICD implantation, positive inotonic drugs, and vasodilator use were suggested to be common factors affecting length of hospital stay in all three groups. Conclusion LVEF, pneumonia, NT⁃proBNP, serum sodium, CRT or ICD implantation, β blockers, aldosterone receptor antagonists, positive inotropic drugs and vasodilators are the influencing factors of hospitalization time in HF patients.

OBJECTIVE To explore the effects of posaconazole combined with proton pump inhibitors （PPI） on the blood concentration and the risk of invasive fungal disease （IFD） in patients with malignant hematological disorder. METHODS In accordance with the random number table method， 40 patients with malignant hematological disorders who were admitted to the hematology department of our hospital between December 2020 and December 2021 were chosen and divided into control group （20 cases） and observation group （20 cases）. The control group received Posaconazole oral suspension alone， while the observation group received Posaconazole oral suspension combined with PPI. The incidence of IFD， attainment rate of blood concentration， the time from the start of prophylaxis to IFD onset， the fatality associated with IFD， treatment of infected patients， and blood concentrations of posaconazole on 7th， 14th， 21st， and 28th day after posaconazole application were compared between 2 groups； the occurrence of adverse events during drug administration in the two groups was recorded. RESULTS The study was stopped because 2 patients in the observation group and 9 patients in the control group received hospital departures after taking posaconazole for fewer than 7 days. The incidence of IFD in the observation group was significantly higher than control group， and the attainment rate of blood concentration in the observation group was significantly lower than control group （P＜0.05）. There was no significant difference in the time from the start of prophylaxis to IFD onset， the fatality associated with IFD， treatment of infected patients and the incidence of adverse events （P＞ 0.05）. The blood concentration of posaconazole in the observation group was significantly lower than control group on 7th day of medication （P＜0.05）； there was no significant in blood concentration of posaconazole between 2 groups on the 14th day of medication （P＞0.05）. CONCLUSIONS Posaconazole combined with PPI can reduce the blood concentration of patients with malignant hematological disorders， increase the risk of IFD. Clinical practice should try to avoid the combination of the two or use them under the guidance of therapeutic drug monitoring.

Fusobacterium nucleatum is an opportunistic pathogenic bacterium that can be enriched in colorectal cancer tissues, affecting multiple stages of colorectal cancer development. The two-component system plays an important role in the regulation and expression of genes related to pathogenic resistance and pathogenicity. In this paper, we focused on the CarRS two-component system of F. nucleatum, and the histidine kinase protein CarS was recombinantly expressed and characterized. Several online software such as SMART, CCTOP and AlphaFold2 were used to predict the secondary and tertiary structure of the CarS protein. The results showed that CarS is a membrane protein with two transmembrane helices and contains 9 α-helices and 12 β-folds. CarS protein is composed of two domains, one is the N-terminal transmembrane domain (amino acids 1-170), the other is the C-terminal intracellular domain. The latter is composed of a signal receiving domain (histidine kinases, adenylyl cyclases, methyl-accepting proteins, prokaryotic signaling proteins, HAMP), a phosphate receptor domain (histidine kinase domain, HisKA), and a histidine kinase catalytic domain (histidine kinase-like ATPase catalytic domain, HATPase_c). Since the full-length CarS protein could not be expressed in host cells, a fusion expression vector pET-28a(+)-MBP-TEV-CarS_cyto was constructed based on the characteristics of secondary and tertiary structures, and overexpressed in Escherichia coli BL21-Codonplus(DE3)RIL. CarS_cyto-MBP protein was purified by affinity chromatography, ion-exchange chromatography, and gel filtration chromatography with a final concentration of 20 mg/ml. CarS_cyto-MBP protein showed both protein kinase and phosphotransferase activities, and the MBP tag had no effect on the function of CarS_cyto protein. The above results provide a basis for in-depth analysis of the biological function of the CarRS two-component system in F. nucleatum.
Humans ; Histidine Kinase/metabolism* ; Fusobacterium nucleatum/metabolism* ; Automobiles ; Protein Kinases/genetics* ; Escherichia coli/metabolism* ; Colorectal Neoplasms

Organ shortage has become one of the major challenges hindering the development of organ transplantation. Xenotransplantation is one of the most valuable methods to resolve global organ shortage. In recent years, the development of genetic engineering technique and research and development of new immunosuppressant have provided novel theoretical basis for xenotransplantation. International scholars have successively carried out researches on xenotransplantation in genetically modified pigs to non-human primates or brain death recipients, making certain substantial progresses. However, most of the researches are still in the preclinical stage, far from clinical application. Therefore, according to the latest preclinical experimental research progress at home and abroad, the history of xenotransplantation, the development of gene modification technology, xenotransplantation rejection and immunosuppression regimens were reviewed, aiming to provide reference for subsequent research of xenotransplantation, promote clinical application of xenotransplantation and bring benefits to more patients with end-stage diseases.