Human pluripotent stem cells provide an inexhaustible model to study human embryogenesis in vitro. Recent studies have provided diverse models to generate human blastoids by self-organization of different pluripotent stem cells or somatic reprogramming intermediates. However, whether blastoids can be generated from other cell types or whether they can recapitulate postimplantation development in vitro is unknown. Here, we develop a strategy to generate human blastoids from heterogeneous intermediates with epiblast, trophectoderm, and primitive endoderm signatures of the primed-to-naïve conversion process, which resemble natural blastocysts in morphological architecture, composition of cell lineages, transcriptome, and lineage differentiation potential. In addition, these blastoids reflect many features of human peri-implantation and pregastrulation development when further cultured in an in vitro 3D culture system. In summary, our study provides an alternative strategy to generate human blastoids and offers insights into human early embryogenesis by modeling peri- and postimplantation development in vitro.
Humans ; Pluripotent Stem Cells/metabolism* ; Embryo, Mammalian/metabolism* ; Cell Differentiation ; Blastocyst ; Cell Lineage ; Embryonic Development

【Objective】 To evaluate the safety and efficacy of balloon-expandable vertebral body stenting （VBS） in treating elderly patients with osteoporotic vertebral compression fractures. 【Methods】 Thirty-eight elderly patients with osteoporotic vertebral compression fractures were randomly divided into two groups according to the parity of their hospital admission numbers to receive VBS and traditional percutaneous kyphoplasty （PKP）， respectively. The two groups were compared regarding changes in the intensity of pain， functional score， imaging parameters related to vertebral compression， and sagittal Cobb angle as well as the incidence of bone cement leakage after treatment， to evaluate the safety and efficacy of VBS. 【Results】 All the patients underwent the operations smoothly， which were performed with the bilateral percutaneous puncture technique under local anesthesia by the same surgeon， and were followed up for more than half a year. Both VBS group and PKP group showed significant improvement in the visual analogue scale score， the Oswestry disability index， the height of the fractured vertebral body， and the Cobb angle at 3 days， 1 month， 3 months and 6 months after treatment （all P<0.05）. There were significant differences in those indicators between the two groups （all P<0.05）. 【Conclusion】 VBS is an effective treatment approach for elderly patients with osteoporotic vertebral compression fractures. It can effectively recover fractured vertebral body height， relieve patients’ pain， and have fewer complications such as bone cement leakage.

Objective:To compare the value of NoSAS score, STOP-BANG questionnaire (SBQ) and Epworth Sleepiness Scale (ESS) in assessing the risk of obstructive sleep apnea hypopnea syndrome (OSAHS) in patients with respiratory disease (RD).Methods:The clinical data, NoSAS, SBQ and ESS scores of 190 patients who underwent overnight polysomnography (PSG) were collected. According to the receiver operating characteristic (ROC) curve, with different apnea-hypopnea index (AHI) as the judgment cutoff, the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratio (DOR) and accuracy of the three scales were compared.Results:With AHI ≥5 times/h as the cutoff, the area under the ROC curve (AUC) of NoSAS and SBQ were 0.833 and 0.729, respectively, indicating that both have predictive value for mild OSAHS. Among them, NoSAS had a larger DOR value (16.150), indicating that NoSAS had the higher accuracy in assessing the risk of mild OSAHS. When AHI>15 times/h was used as the cutoff, the AUC value of NoSAS was 0.704, indicating that it has predictive value for moderate OSAHS. When AHI>30 times/h was used as the cutoff, the AUC value (0.706) and DOR value (6.527) of SBQ were high, indicating that it has predictive value and good accuracy for severe OSAHS. The SBQ is more sensitive than NoSAS and ESS when evaluating patients at high risk for OSAHS ( SBQ≥3). Conclusions:When evaluating the risk of mild and moderate OSAHS in RD patients, NoSAS is better than SBQ and ESS, and when evaluating severe OSAHS, SBQ is better than NoSAS and ESS. In clinical work, appropriate predictive tools should be selected according to the actual situation to assess the risk of OSAHS, so as to formulate and implement early intervention plans based on the assessment results.

Objective:To explore the effect of nurse-led management model in adherence of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who underwent non-invasive mechanical ventilation.Methods:92 patients with severe OSAHS diagnosed by polysomnography(PSG) and treated with non-invasive mechanical ventilation in Tianjin medical university general hospital from September 2019 to August 2020 were enrolled. The patients were divided into intervention group (45 cases) and control group (47 cases) by random number table. Then, basing on routine treatment and subsequent visit, the patients in intervention group received regular telephone follow-up interviews within one week of ventilator purchasing, and the interview was based on a standard telephone follow-up manuscript designed by Duffy and lasted for six months. The patients in control group received routine nursing treatment and regular subsequent visit, and were not followed up by telephone, but were encouraged to have telephone consultation. The Epworth sleepiness scale(ESS) scores of the two groups before and after the intervention and the compliance of non-invasive mechanical ventilation of the two groups after the intervention were compared.Results:After the intervention, the ESS scores of the two groups were lower than those before the intervention ( P<0.001), and the ESS scores of the intervention group were lower than those of the control group ( P<0.001). After the intervention, the compliance of noninvasive mechanical ventilation in the intervention group was better than that in the control group ( P<0.001). Conclusions:The nurse-led management model in combination with telephone follow-up can improve the sleepiness of patients and the adherence of using non-invasive mechanical.

Objective:To understand the situation of death reports of HIV/AIDS patients in China from 2011 to 2019, including the situation of reporting delay and the risk factors of reporting delay, and to provide scientific basis for formulating relevant policies.Methods:The Joinpoint regression model was used to describe the changing trend of the proportion of HIV/AIDS patients who were reported within 6 months after death, and the logistic regression model was used to analyze the risk factors of delayed-reporting of HIV/AIDS deaths.Results:From 2011 to 2019, 241, 019 cases of HIV/AIDS patients were reported dead in China, and 237, 282 cases were included in the study. The proportion of reporting within 6 months after death declined during 2011-2018 (APC=-0.57%, p=0.047). Logistic regression model showed that ethnic minorities ( OR=1.34, 95% CI: 1.29-1.39), domestic workers and unemployed workers ( OR=1.52, 95% CI: 1.48~1.61), high school education or above ( OR=1.15, 95% CI: 1.09~1.20), patients who were over 45 years old when they were diagnosed ( OR=1.16, 95% CI: 1.12~1.21), duration of diagnosis was more than six months ( OR=1.63, 95% CI: 1.57~1.70), infection route was heterosexual transmission ( OR=1.21, 95% CI: 1.13~1.30) or injection drug ( OR=1.26, 95% CI: 1.17~1.36) and the inconsistency between the permanent residence registration place and the reporting place ( OR=1.08, 95% CI: 1.04~1.13) are more prone to delayed-reporting, in the cases of divorced or widowed ( OR=0.87, 95% CI: 0.84~0.91) patients, those who were receiving national free antiviral treatment ( OR=0.78, 95% CI: 0.76~0.81), and the death place was located in medical institutions ( OR=0.90, 95% CI: 0.86~0.94) and no loss to follow-up at the last follow-up before death ( OR=0.25, 95% CI: 0.24~0.26) deaths were more likely to be reported in time. Conclusions:From 2011 to 2019, 91.63% of the dead HIV/AIDS patients in China can be reported within 6 months, and the proportion of the dead HIV/AIDS patients reported within 6 months from 2011 to 2018 shows a slightly downward trend. Ethnic minorities, those who are engaged in domestic work and unemployed, high school or above education, patients who were over 45 years old when they were diagnosed, duration of diagnosis was more than six months, infection route was heterosexual transmission or injection drug and the inconsistency between the permanent residence registration place and the reporting place are the risk factors for delayed-reporting, while divorce or widowhood, receiving antiviral treatment, dying in medical institutions, no loss to follow-up at the last follow-up visit before death are the protective factors for delayed-reporting.

To explore the effect of IL-33 on various tumor types,exogenous injection of recombinant mouse IL-33 protein (mIL-33) was used to study the efficacy of different subcutaneous tumor-bearing mouse models. In this study,mIL-33 has been found to significantly inhibit the growth of liver,lung,gastric,prostate,and colon cancers. However,the inhibition of tumor growth by mIL-33 was not completely consistent in different types of tumor. A lower dose of mIL-33 (10 μg/kg) significantly inhibited tumor growth in subcutaneous tumor-bearing mice of liver,lung,and gastric cancers,while a higher dose of mIL-33 (90 μg/kg) was required to exert the corresponding antitumor effect in subcutaneous tumor-bearing mouse models with prostate and colon cancers. In addition,the growth inhibitory effect of mIL-33 on subcutaneous tumors of colon cancer was also correlated with the duration of administration and the stage of tumor progression. The results of this study indicate that mIL-33 significantly inhibits the growth of a variety of tumors,suggesting that IL-33 might be an effective target for tumor treatment.

Objective:To explore the influence of multidimensional integration and 360° support on the function of family and marriage, and quality of life in women patients with systemic lupus erythematosus.Methods:Totally 196 patients with systemic lupus erythematosus from Department of Rheumatology and Immunology, The Second Affiliated Hospital of the Air Force Medical University from August 2016 to November 2017 were included. According to random number table method, these patients were divided into observation group and control group as 98 cases each. Conventional care and hospital discharge were used for control group. On the basis of this, multidimensional integration and 360° support were used for patients of observation group. The function of family and marriage, quality of life in patients were assessed before and after 3 months of the intervention. The treatment adherence was evaluated in 3 months and 6 months after intervention.Results:Before intervention, the marriage family function score, marital satisfaction, conflict resolution methods and the relationship with friends and family, husband and wife exchange scores of the observation group were (2.3 ± 0.5), (24.6 ± 6.1), (25.7 ± 7.1), (28.2 ± 6.9), (28.8 ± 6.9) points, respectively. Three months after intervention, these scores were (2.5 ± 0.7), (31.6 ± 5.0), (31.7 ± 5.3), (28.1 ± 6.8), (29.0 ± 7.1) points, respectively. There was statistically significant difference between before and after the intervention ( t values were -2.371 - 8.631, P < 0.01). These scores of control group before the intervention were (2.3 ± 0.6), (24.5 ± 6.2), (25.2 ± 7.2), (32.5 ± 6.0), (33.9 ± 6.3) points, respectively. Three months after intervention, these scores were (2.3 ± 0.4), (24.5 ± 6.2), (26.1 ± 6.9), (29.1± 4.8), (28.5 ± 7.2) points. Significant differeces were found between before and after the intervention in control group ( t values were -3.878-6.323, P < 0.05 or 0.01). There was statistically significant difference between the two groups after the intervention ( t values were 2.675-8.631, P<0.01). As for observation group, planning (62.8 ± 27.2 vs. 75.5 ± 25.4) and intimate relationship (62.8 ± 25.2 vs. 78.2± 24.9) in quality of life were obviously difference before and after 3 months of intervention ( t values were 3.050, 3.639, P < 0.01). As for control group, planning (62.5 ± 27.6 vs. 65.7 ± 24.9) and intimate relationship (65.8 ±25.2 vs. 63.5 ± 23.8) in quality of life were obviously difference before and after 3 months of intervention ( t values were 2.375, 3.132, P < 0.01). There was statistically significant difference between the two groups after the intervention ( t values were 3.050, 3.639, P < 0.01). The treatment adherence of observation group was significant better than control group. After 6 months intervention, the treatment adherece of observation group was 83.67% (82/98), while the treatment adherece of control group was 44.89% (44/98), significant differences were found btween the two groups ( χ2 value was 0.511, P < 0.01). Conclusion:Multidimensional integration and 360° support obviously improved function of family and marriage, improved the understanding of disease, and self-management ability of patients. Therefore, it can increase the treatment adherence and improve quality of life in SLE patients.

In May 2019, the International Diabetic Foot Working Group (IWGDF) updated and issued guidelines for the prevention and management of diabetic foot disease. This guide puts forward some suggestions for the diagnosis, treatment and effective prevention of diabetic foot: the prevention of diabetic foot should start with high-risk foot, early screening and treatment of diabetic foot infection, foot ulcer and peripheral vascular disease and early comprehensive treatment. Effective prevention and early treatment can reduce the incidence of cardiovascular and cerebrovascular events in patients with diabetes, reduce the amputation rate and mortality, and improve the prognosis and quality of life of patients.

Objective To assess the clinical utility of measurement of plasma heparin-binding protein (HBP) in diagnosis and prognosis of sepsis.Methods This is a retrospective study on the performance of plasma heparin-binding protein, procalcitonin and C-reaction protein in the early diagnosis of sepsis. Thirty-one patients with sepsis, 16 patients with severe sepsis, 12 patients with septic shock and 37 control patients without confirmed sepsis, all admitted to the Intensive Care Units (ICU) of the Third Hospital Affiliated to Wenzhou Medical University and Wenzhou Central Hospital from August 2014 to November 2016, were enrolled in the study. The plasma level of HBP, procalcitonin (PCT) and C-reactive protein (CRP) were measured, and the detailed clinical data were retrieved from the patient chart records for all patients described above. Comparison of each laboratory and clinical parameters between groups was carried out by Non-parameter Test. The efficiency of each parameter was calculated by receiver operating characteristics curves (ROC) analysis. The correlation between HBP, PCT or CRP and clinical or other laboratory parameters was explored using Spearman correlation analysis.Results HBP was significantly elevated in patients with severe sepsis[(100.65±58.82)ng/ml and(31.86±36.87)ng/ml,Z=-3.856,P<0.05;(100.65±58.82)ng/ml and(24.96±17.49)ng/ml,Z=-3.556,P<0.05]and in patients with septic shock[(148.28±99.73)ng/ml and(31.86±36.87)ng/ml,Z=-4.432,P<0.05;(148.28±99.73)ng/ml and(24.96±17.49)ng/ml,Z=-4.157,P<0.05], respectively, while CRP[(154.64±62.90)mg/L and(92.56±67.49)mg/L,Z=-2.749,P<0.05;(154.64±62.90)mg/L and (79.21±51.80)mg/L,Z=-3.218,P<0.05]and PCT[(32.86±39.93)ng/ml and(2.70±6.24)ng/ml,Z=-3.395,P<0.05;(32.86±39.93)ng/ml and(4.21±14.94)ng/ml,Z=-4.092,P<0.05]were increased only in patients with septic shock (P<0.05).For HBP, the area of under the ROC curves (AUC) was the biggest (AUC=0.687), indicating the clinical significance(P<0.05) with excellent sensitivity(0.729) at the optimal cut-off value(18.58 ng/ml). In addition, HBP(APTT: r=0.244, P=0.016;PT: r=0.351, P<0.001;INR: r=0.314, P=0.002;D-Dimer: r=0.334, P=0.001;lactic acid: r=0.394, P<0.001), CRP(APTT: r=0.271, P=0.008;PT: r=0.348, P=0.001;INR: r=0.264, P=0.009;D-Dimer: r=0.257, P=0.012;lactic acid: r=0.329, P=0.001) and PCT(APTT: r=0.375, P<0.001;PT: r=0.523, P<0.001;INR: r=0.535, P<0.001;D-Dimer: r=0.254, P=0.013;lactic acid: r=0.422, P<0.001)were positively correlated to coagulation function and to lactate.Conclusion HBP could probably be acted as an important biomarker for diagnosis and prognosis for patients with sepsis, esp., for patients with severe sepsis and septic shock.

Researches show that exosome can take park in the development and progression of breast cancer by means of mediating the intercellular communication,which can promote cancer metastasis and drug resistance,thus influencing the treatment effect of patients with cancers.Exosome is closely related with clinical stage and prognosis of breast cancer,which has a potential value in the early diagnosis and biological therapy of breast cancer and provides a new hope for the treatment of breast cancer.