BACKGROUND:Stem cel s have the potential to differentiate into various organs and tissues. In recent years, stem cel s have been proved to differentiate into hair fol icles under certain conditions. OBJECTIVE:To review the research progress and prospect of stem cel s differentiating to hair fol icles, thereby providing a reliable basis for clinical treatment of serious hair fol icle injury. METHODS:A computer-based search of PubMed, EMBASE, WanFang, CNKI databases was performed for related articles published between 2013 and 2015, using the keywords of“cel hair, fol icle stem, medicine regenerative, differentiation”in English and Chinese. A total of 207 articles were retrieved, and final y 34 articles were included in result analysis. RESULTS AND CONCLUSION:Stem cel s from different sources al have the ability to differentiate into hair fol icles under certain inductions. However, it is important to seek more scientific and rational methods for the differentiation of stem cel s into hair fol icles based on overcoming their own shortcomings. A great progress has been made in animal experiments and subclinical trials, and even a great breakthrough in some aspects. Further studies on combining the advantages and overcoming the shortcomings of various stem cel s during differentiation are required for the clinical treatment of serious hair fol icle injury.

OBJECTIVE:To optimize the formulation of Mirabegron sustained-release tablets. METHODS:Using polyethylene oxide(PEO)and hydroxypropylmethyl cellulose(HPMC K4M)as the sustained release matrix,Mirabegron sustained-release tab-lets were prepared by powder direct compression technology. Using 1,3,5,7 h accumulative release rate as indexes,the amounts of PEO,HPMC K4M and OPADRY? were optimized by composite design-response surface method,and then validated. Accumula-tive release rates of sustained-release tablet and original tablet (MyrbetriqTM) were compared in different pH mediums (water,pH 1.0 simulated gastric fluid,pH 4.5 acetate buffer solution,pH 6.8 phosphate buffer solution) at different rotation rates (100,50 r/min),and similiar factor f2 was calculated to fit drug release model of sustained-release tablet. RESULTS:In the optimized firmu-lation each Mirabegron sustained-release tablet contained mirabegron 25 mg,PEO 108.02 mg,HPMC K4M 21.69 mg,OPADRY? 2.27%. Relative error of accumulative release rates at 1,3,5,7 h to predicted value were 4.78%,3.48%,0.69% and -1.41%, respectively. f2 of release curves of sustained-release tablet and original tablet were higher than 65 in different pH medium at differ-ent rotation rates. The drug release of sustained-release tablet was fitted to zero-order release equation. CONCLUSIONS:Mirabe-gron sustained-release tablet by optimized technology is similar to original tablet in drug release behavior.

With the aging of the population and the change of disease spectrum in China, the number of emergency department patients at the elderly, chronic end-stage, advanced tumor and cerebrovascular accident is increasing gradually, and the quality of life in emergency end of life patients is getting more and more attention. This paper reviews the relevant literature of "do not resuscitate" (DNR) in emergency department at home and abroad, introduces the current status of DNR application and the influencing factors of decision-making in emergency department at home and abroad, in order to provide reference for the application and practice of DNR in emergency department in China.

Traditional therapies for alopecia areata, especially moderate to severe alopecia areata and special types of alopecia areata, remain unsatisfactory. Compared with traditional therapies, small-molecule targeted drugs and biological agents have advantages of a more rapid onset of action and more marked efficacy, however, some patients may experience adverse reactions such as infections during treatment or relapses after drug withdrawal. Thus, their efficacy and safety still need to be further evaluated. This review summarizes research progress in small-molecule targeted drugs and biological agents in the treatment of alopecia areata.

Objective:To analyze the MRI characteristics of surgical resected renal angiomyolipoma (AML) smaller than 4 cm.Methods:A total of 112 patients with surgical pathology confirmed renal AML of which the maximum diameter was smaller than 4 cm were analyzed retrospectively in the First Medical Centre, Chinese PLA General Hospital from January 2014 to November 2020, 5 of which were epithelioid angiomyolipoma (EAML) patients. According to the presence or absence of visible fat in lesions on MRI, the lesions were divided into AML with fat group and AML without visible fat (AML wovf) group. The MRI features were evaluated, including maximum diameter, location, growth pattern, shape, beak sign, angular interface with renal parenchyma, pseudo-capsule, hemorrhage, cystic degeneration, coagulative necrosis, flowing void in the tumor, signal intensity and homogeneity on T 2WI and diffusion weighter imaging (DWI), the peak enhanced phase. The differences of maximum diameter of AML with fat and AML wovf were analyzed using Mann-Whitney U test, and the differences of MRI features were analyzed using χ 2 test or Fisher′s exact probability test. Results:There were 123 lesions found in 112 patients, and 96 lesions contained fat and 27 lesions were AML wovf. 82 lesions showed round and round-like shapes, 112 lesions showed exophytic growth pattern, 71 lesions with peak enhancement in corticomedullary phase. And the numbers of lesions with angular interface with renal parenchyma, beak sign, cystic degeneration, pseudo-capsule, hemorrhage were 30, 49, 1, 1, 1, respectively. There was no coagulative necrosis in all lesions. Compared with AML with fat, AML wovf was single lesion. The diameters of AML with fat and AML wovf were 2.5 (1.7, 3.5) and 1.8 (1.4, 2.3) cm respectively, with statistically significant difference ( Z=-2.80, P=0.005). In the AML with fat and AML wovf, 65 and 12 cases were heterogeneous in T 2WI, 44 and 5 lesions showed beak sign, 26 and 4 lesions showed angular interface with renal parenchyma, 57 and 10 cases were heterogeneous in DWI. And there were 5 and 6 lesions showed the endophytic, 44 and 8 lesions showed partly exophytic, 47 and 13 lesions showed exophytic in patterns of tumor growth respectively. The beak sign, homogeneous in T 2WI and DWI, patterns of tumor growth showed statistical differences in AML with fat and AML wovf (all P<0.05), and there was no significant difference in other features ( P>0.05). A total of 5 EAML patients were with 8 lesions. One patient had 4 lesions with fat, other patients had single lesion in which 2 lesions with fat, 2 lesions without visible fat. One lesion without visible fat showed hemorrhage. Conclusions:Surgical resected AML smaller than 4 cm is often exophytic round and round-like, enhanced in corticomedullary phase, showing angular interface with renal parenchyma and beak sign, with rare cystic degeneration, pseudo-capsule, hemorrhage and improbable coagulation necrosis. AML wovf is single smaller lesion which often shows endophytic growth pattern, and beak sign is infrequent. EAML seems to be present in two modes, multiple lesions with fat and AML wovf with hemorrhage.

Portal vein thrombosis (PVT) is divided into cirrhotic and non-cirrhotic PVTs. The incidence rate of PVT varies greatly among different clinical stages of cirrhosis, with an overall incidence rate of about 13.92%, and the prevalence of cirrhotic PVT following splenectomy is as high as 60%. The pathogenesis of cirrhotic PVT is still unclear. However, the activation of Janus kinase/signal transduction and activator transcription signaling pathways, the rise in the expression of von Willebrand factor, and the gut microbiota along with its metabolite trimethylamine-N-oxide play an important role in the injury of vascular endothelial cells and the formation of PVT in cirrhosis. Therefore, these could be a new target for cirrhotic PVT prevention and treatment.

Objective To explore the relationship between serum high mobility group protein B1(HMGB1)level and anxiety symptoms in patients with cerebral small vessel disease(CSVD).Methods A total of 165 CSVD patients admitted in our department from December 2022 to July 2023 were enrolled as the research subjects.All of them were evaluated by neurologists with Hamilton Anxiety Rating Scale(HAMA),and then those with HAMA score ≥7 were assigned into an anxiety group(70 cases),and the other into a non-anxiety group(95 cases).Non paramet-ric rank sum test was used to compare the serum level of HMGB1 between the two groups of pa-tients.Logistic regression analysis was employed to analyze the risk factors affecting anxiety symptoms in CSVD patients.ROC curve was plotted to evaluate the predictive value of HMGB1 for anxiety symptoms in the patients.Results The serum HMGB1 level was significantly higher in the anxiety group than the non-anxiety group[287.01(188.19,355.54)ng/L vs 260.87(146.48,328.16)ng/L,P＜0.05].Multivariate logistic regression analysis showed that after adjusting for confounding factors,serum HMGB1 level was still a risk factor for anxiety symptoms in CSVD patients(OR=1.004,95％CI:1.000-1.007,P=0.046).Spearman correlation analysis indicated that HMGB1 level was positively correlated with total score of HAMA,insomnia score,and psy-chogenic score(P＜0.05,P＜0.01).The AUC value of HMGB1 in predicting anxiety symptoms in CSVD patients was 0.609(P=0.020).Conclusion Serum HMGB1 level is associated with the oc-currence of anxiety symptoms in CSVD patients,and it has predictive value for the anxiety symp-toms in CSVD patients.

Objective In order to improve the"high-dose blood transfusion procedure",shorten the preparation time for blood transfusion in patients with clinical traumatic hemorrhagic shock,and improve the outcome of patients.Methods Patients with emergency traumatic hemorrhagic shock from January to December 2021 were selected as the study subjects.Patients who received improved high-dose transfusion procedures from July to December were selected as the experimental group,and patients who received conventional transfusion procedures from January to June were selected as the control group.The timeliness indexes and outcome indexes of the 2 groups were compared.Results The delivery time for blood type and routine examination was shortened from 15 min to 8 min(U=143.50,P=0.024);transfusion preparation time was shortened from 31 min to 19 min(U=126.50,P=0.026);the time for decision-making blood preparation was shortened from 44 min to 18 min(U=152.50,P=0.007);emergency stay time was shortened from 135 min to 114 min(U=91.50,P=0.036);the outcome distribution of patients(x2=10.64,P=0.031)was improved.Conclusion The improved high-dose blood transfusion procedure can significantly shorten the blood transfusion preparation time for patients with traumatic hemorrhagic shock and improve the treatment rate of patients.

Objective:To investigate the clinical and MRI features of the mixed epithelial and stromal tumor family (MESTF) of the kidney.Methods:From January 2009 to September 2021, 42 patients with pathologically-proven MESTF from the First Medical Center of Chinese PLA General Hospital were collected in this retrospective study. Clinical information, MRI features, and pathological results were documented. According to the Bosniak classification (BC) version 2019, all MESTFs were divided into cystic MESTFs (36 cases) and solid-cystic MESTFs (6 cases). The R.E.N.A.L. nephrometry score (RNS), lesion size, laterality, location, margin, shape, growth pattern, presence of protruding into renal sinus, hemorrhage, and enhancement pattern were evaluated and documented. Based on BC versions 2005 and 2019, all the cystic MESTFs were assessed and divided into low (Ⅰ, Ⅱ, ⅡF) and high (Ⅲ, Ⅳ) grades. The independent sample t test or Mann-Whitney U test were performed to compare age, RNS, and lesion size between cystic MESTFs and solid-cystic MESTFs. Pearson χ 2 test, continuity-adjusted χ 2 test or Fisher exact probability test were utilized to evaluated the differences of clinical and MRI features and the distribution of low or high grades in two versions of BC. Results:Forty-two MESTFs were unilateral and solitary masses, 25 males and 17 females, with a mean age of (41±13) years old. Compared to solid-cystic MESTFs, cystic MESTFs were prone to demonstrate endophytic growth pattern (χ 2=17.77, P<0.001), and no significant differences in other clinical and MRI features were observed between cystic and solid-cystic MESTFs (all P>0.05). There were 7 low-grade and 29 high-grade tumors in the BC version 2005, respectively. Meanwhile, 24 low-grade and 12 high-grade tumors in the BC version 2019, respectively. The distribution of low or high-grade tumors in the two versions of BC had a statistically significant difference (χ 2=16.37, P<0.001). Conclusion:MESTFs demonstrated middle-age onset and no gender predilection. Cystic MESTFs are more likely to exhibit endophytic growth pattern with low-grade classification in BC system version 2019.

Objective:To study the epidemiological characteristics and spatio-temporal aggregation of hemorrhagic fever with renal syndrome (HFRS) in Shandong Province, and to provide reference for formulating reasonable prevention and control strategies.Methods:Retrospective analysis was used to collect HFRS surveillance data and confirmed case data in Shandong Province from 2017 to 2020 in the "China Disease Prevention and Control Information System Infectious Disease Surveillance System". Geoda 1.18 software was used for global and local spatial autocorrelation analysis, SaTScan 9.6 software was used for spatio-temporal scanning analysis, and ArcGis 10.7 software was used for map drawing and visual display.Results:A total of 3 753 cases of HFRS were reported in Shandong Province from 2017 to 2020, including 56 deaths. The annual incidence rate was 1.26/100 000, 1.22/100 000, 0.75/100 000 and 0.53/100 000, respectively, with an average annual incidence rate of 0.94/100 000. The incidence of HFRS was obviously seasonal, mainly concentrated in autumn and winter from October to December, accounting for 50.41% (1 892/3 753). The age of onset was mainly 30-59 years old, accounting for 61.68% (2 315/3 753). The male to female ratio was 2.76 ∶ 1.00 (2 756 ∶ 997). The occupation distribution was mainly farmers, accounting for 81.99% (3 077/3 753). The global spatial autocorrelation analysis showed that HFRS showed spatial aggregation areas in each year from 2017 to 2020 (Moran' I = 0.38, 0.33, 0.59, 0.46, Z = 7.47, 7.23, 10.69, 8.66, P < 0.001). The local spatial autocorrelation analysis showed that "high-high" aggregation areas were mainly concentrated in central and southeast of Shandong Province, while "low-low" aggregation areas were mainly concentrated in northwest of Shandong Province. Spatio-temporal scanning analysis revealed 1 type Ⅰ agglomerations and 2 type Ⅱ aggregation areas. The type Ⅰ aggregation areas occurred from October to November 2018, covering 22 counties (districts) of 5 cities in Qingdao, Yantai, Weifang, Weihai and Rizhao. The first type Ⅱ aggregation area occurred from October to November 2017, involving 23 counties (districts) of 8 cities in Jinan, Zibo, Zaozhuang, Weifang, Jining, Tai 'an, Rizhao and Linyi. The second type Ⅱ aggregation area occurred in Jinxiang County, Jining City from February to March 2017. Conclusion:The incidence of HFRS in Shandong Province from 2017 to 2020 has obvious spatio-temporal aggregation, and the hot spots are concentrated in central and southeast of Shandong Province, which should be regarded as a key area for prevention and control of HFRS.