BACKGROUND:Exosomes,as a type of extracellular vesicle,have become a key medium for cell-to-cell communication due to their nanoscale size and enrichment of various bioactive substances.The study of exosome secretion regulation not only has important scientific value,but also has broad application prospects in clinical practice,and is of great significance for promoting medical progress and improving human health.OBJECTIVE:To review the biological characteristics,biological functions,biogenesis process and biochemical regulation mechanism of exosomes,and to explore the application prospects of exosomes in disease diagnosis,treatment and vaccine development,so as to provide theoretical basis and reference for basic research and clinical transformation of exosomes.METHODS:The first author searched PubMed and CNKI databases in October 2024 for relevant literature published from January 2010 to October 2024.Key words were"exosomes,biological functions,biogenesis,secretion or release,regulatory mechanisms,application prospects"in Chinese and English.Finally,92 articles were included for analysis.RESULTS AND CONCLUSION:The secretion level of exosomes can be regulated through physical or biochemical means.Exosomes show broad application prospects in the fields of disease diagnosis,treatment,and vaccine development,and may play a key role in the treatment of cardiovascular and cerebrovascular diseases as well as cancer.This review provides valuable information for the clinical translation and application research of exosomes,helping to promote future progress in exosome research and application.

BACKGROUND:Exosomes,as a type of extracellular vesicle,have become a key medium for cell-to-cell communication due to their nanoscale size and enrichment of various bioactive substances.The study of exosome secretion regulation not only has important scientific value,but also has broad application prospects in clinical practice,and is of great significance for promoting medical progress and improving human health.OBJECTIVE:To review the biological characteristics,biological functions,biogenesis process and biochemical regulation mechanism of exosomes,and to explore the application prospects of exosomes in disease diagnosis,treatment and vaccine development,so as to provide theoretical basis and reference for basic research and clinical transformation of exosomes.METHODS:The first author searched PubMed and CNKI databases in October 2024 for relevant literature published from January 2010 to October 2024.Key words were"exosomes,biological functions,biogenesis,secretion or release,regulatory mechanisms,application prospects"in Chinese and English.Finally,92 articles were included for analysis.RESULTS AND CONCLUSION:The secretion level of exosomes can be regulated through physical or biochemical means.Exosomes show broad application prospects in the fields of disease diagnosis,treatment,and vaccine development,and may play a key role in the treatment of cardiovascular and cerebrovascular diseases as well as cancer.This review provides valuable information for the clinical translation and application research of exosomes,helping to promote future progress in exosome research and application.

OBJECTIVE To evaluate the application effect of implementation strategies in the prevention and control of sur-gical site infection(SSI),and to review its research progress.METHODS A scoping review method was employed,invol-ving systematic searches across databases such as Web of Science,PubMed,Cochrane,CNKI and Wanfang.After screening based on the inclusion and exclusion criteria,the included literature was analyzed and reported in a standard-ized manner.RESULTS A total of 47 articles were included.Most studies adopted comprehensive evidence-based practices(EBP)(≥2 types)and employed multimodal implementation strategies(≥3 items)to facilitate the implementation of SSI prevention and control EBP.Within the framework of the WHO multimodal strategy,42,39,39 and 24 studies re-spectively applied the four implementation strategies of system change,education and training,monitoring and feedback and reminder and communication,while only 9 studies applied the strategy of creating a safety culture.The highest pro-portion of studies(31.91％,15/47)employed a combination of four implementation strategies,with the common combi-nation being"system change+education and training+monitoring and feedback+reminder and communication"(29.79％,14/47),and this combination of four implementation strategies demonstrated outstanding performance in en-hancing EBP compliance.Totally 26(55.32％)showed decrease in the incidence of SSI after intervention(P＜0.05).CONCLUSIONS Implementation strategies are crucial for the successful implementation of SSI prevention and con-trol EBP.Multimodal implementation strategies are common approaches to facilitate the implementation of EBP.In the future,it is necessary to further standardize the application of scientific methods and improve the effect evaluation of im-plementation strategies,providing a reference for the sustained and widespread application of EBP in clinical practice.

Objective To investigate the situation of hepatitis B immune blocking and the growth and development of hepatitis B exposed children within one year after birth, and to provide evidence for formulating and optimizing measures for maternal and infant blocking in Wenzhou. Methods The hepatitis B infection status during pregnancy and birth was collected, hepatitis B immunoglobulin and vaccine were analyzed, and a follow-up on the immune blocking effect, growth and development, and the nutritional status of children exposed to hepatitis B was conducted. Statistical analysis of data was carried out through SPSS 26.0. Results In 2021, 6.07% of newborns in Wenzhou were exposed to hepatitis B, of which 28.37% were highly exposed children. The prevalence rates for males and females were 6.42% and 5.70%, respectively, and the difference was statistically significant (χ²=13.744, P<0.001). The prevalence rates in mountainous and non-mountainous counties were 6.35% and 5.94%, respectively, and the difference was statistically significant (χ²=5.72, P < 0.001). In 2021, the mother-to-child transmission rate of children exposed to hepatitis B was 0.54‰. There were no significant differences in the height, weight, hemoglobin and neuropsychological development of hepatitis B exposed children compared with non-exposed children (P < 0.001). Conclusion The number of children exposed to hepatitis B in mountainous counties is significantly higher than that in non-mountainous counties in Wenzhou, and the number of men is significantly higher than that of women. The proportion of highly exposed children is relatively high. The effect of mother-to-child blocking is good, and there is no significant difference between the growth and development of children exposed to hepatitis B and no-exposed children during follow-up.

Objective:To evaluate the value of noninvasive assessment of the 13C-methacetin breath test (13C-MBT) based on infrared isotope spectrometry for liver function reserve in patients with nonalcoholic fatty liver disease (NAFLD). Methods:A total of 120 NAFLD patients met the diagnostic criteria,who admitted to Department of Liver Diseases of the First Affiliated Hospital of Xinjiang Medical University from January 2023 to January 2024,were prospectively selected. Patients were divided into three groups based on liver stiffness measurement (LSM) of FibroTouch:mild fibrosis group (LSM<7.0 kPa,n=40),moderate fibrosis group (7.0≤LSM<9.5 kPa) and severe fibrosis group (LSM≥9.5 kPa,n=40). Meanwhile,40 healthy subjects were selected as a healthy control group. All subjects underwent 13C-MBT and conventional liver function tests. The differences of 13C-MBT parameters and liver function indicators among various groups were compared,and the correlations between 13C-MBT parameters and the degree of liver fibrosis,and between liver function indexes and the degree of liver fibrosis were analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the judgment ability of 13C-MBT parameters to the degree of liver fibrosis. Results:The 13C-MBT parameters in NAFLD patients were lower than those in healthy control group,and the differences were statistically significant (F=27.413,28.635,29.851,P<0.05). With the aggravation of liver fibrosis,13C-MBT parameters in NAFLD patients gradually decreased. The 13C-MBT parameters of severe fibrosis group were significantly lower than those in the mild and moderate fibrosis groups,with statistically significant differences (t=12.331,13.020,14.232,22.033,21.032,29.332,P<0.05),respectively. The 13C-MBT parameters were positively correlated with liver function indicators,and were negatively correlated with LSM,and the absolute values of the correlation coefficients were>0.5,all of them showed statistically significant differences (r=0.375,-0.875,P<0.05). The 13C-MBT parameters had higher sensitivity and specificity in judging the degree of liver fibrosis. Taking MVmax40 as an example,when the limit value was 9.5 kPa,the sensitivity was 86.3％,and the specificity was 83.8％,and the accuracy was 85.0％,and the area under curve (AUC) was 0.913. Conclusion:13C-MBT based on infrared isotope spectrometry is a non-invasive,safe,rapid and accurate detection method,which can reflect the liver function reserve and liver fibrosis degree of NAFLD patients,and has important clinical value for the diagnosis and treatment of NAFLD.

Objective:To evaluate the value of noninvasive assessment of the 13C-methacetin breath test (13C-MBT) based on infrared isotope spectrometry for liver function reserve in patients with nonalcoholic fatty liver disease (NAFLD). Methods:A total of 120 NAFLD patients met the diagnostic criteria,who admitted to Department of Liver Diseases of the First Affiliated Hospital of Xinjiang Medical University from January 2023 to January 2024,were prospectively selected. Patients were divided into three groups based on liver stiffness measurement (LSM) of FibroTouch:mild fibrosis group (LSM<7.0 kPa,n=40),moderate fibrosis group (7.0≤LSM<9.5 kPa) and severe fibrosis group (LSM≥9.5 kPa,n=40). Meanwhile,40 healthy subjects were selected as a healthy control group. All subjects underwent 13C-MBT and conventional liver function tests. The differences of 13C-MBT parameters and liver function indicators among various groups were compared,and the correlations between 13C-MBT parameters and the degree of liver fibrosis,and between liver function indexes and the degree of liver fibrosis were analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the judgment ability of 13C-MBT parameters to the degree of liver fibrosis. Results:The 13C-MBT parameters in NAFLD patients were lower than those in healthy control group,and the differences were statistically significant (F=27.413,28.635,29.851,P<0.05). With the aggravation of liver fibrosis,13C-MBT parameters in NAFLD patients gradually decreased. The 13C-MBT parameters of severe fibrosis group were significantly lower than those in the mild and moderate fibrosis groups,with statistically significant differences (t=12.331,13.020,14.232,22.033,21.032,29.332,P<0.05),respectively. The 13C-MBT parameters were positively correlated with liver function indicators,and were negatively correlated with LSM,and the absolute values of the correlation coefficients were>0.5,all of them showed statistically significant differences (r=0.375,-0.875,P<0.05). The 13C-MBT parameters had higher sensitivity and specificity in judging the degree of liver fibrosis. Taking MVmax40 as an example,when the limit value was 9.5 kPa,the sensitivity was 86.3％,and the specificity was 83.8％,and the accuracy was 85.0％,and the area under curve (AUC) was 0.913. Conclusion:13C-MBT based on infrared isotope spectrometry is a non-invasive,safe,rapid and accurate detection method,which can reflect the liver function reserve and liver fibrosis degree of NAFLD patients,and has important clinical value for the diagnosis and treatment of NAFLD.

Objective:To investigate the clinical characteristics and prognosis of T-lymphoblastic lymphoma (T-LBL).Methods:A retrospective case series study was conducted. Clinical data of patients diagnosed with T-LBL at the Affiliated Hospital of Jining Medical University from January 2013 to March 2023 were retrospectively analyzed, and their clinical characteristics and prognosis were statistically analyzed.Results:A total of 22 T-LBL patients were included. Among them, there were 19 males (86.4%) and 3 females (13.6%), and the median age at onset was 19.5 (15, 28) years old. Based on Ann Arbor staging, 3 cases (13.6%) were classified as stage Ⅰ-Ⅱ, while 19 cases (86.4%) were stage Ⅲ-Ⅳ; 10 cases (45.5%) presented with B symptoms, 12 cases (54.5%) without B symptoms; 16 cases (72.7%) showed elevated lactic dehydrogenase (LDH) level. At onset, 7 patients (31.8%) had mediastinal masses, 3 patients (13.6%) had central nervous system involvement, and 17 patients (77.3%) had bone marrow involvement. The overall response rate (ORR) and complete remission rate among the 22 patients were 81.82% (18/22) and 31.82% (7/22), respectively. The ORR was 84.21% (16/19) in 19 patients treated with ALL-like regimens. Among 3 patients treated with NHL-like regimens, 1 case achieved complete remission and 1 case achieved partial remission. Seven patients received allogeneic hematopoietic stem cell transplantation, with a median overall survival (OS) time of 22 months; the median OS time of patients without allogeneic hematopoietic stem cell transplantation was 14 months. The 3-year OS rates in the allogeneic hematopoietic stem cell transplantation group and group without allogeneic hematopoietic stem cell transplantation were 64.30% and 16.00%, and the difference in OS between the two groups was statistically significant ( P = 0.043). Two patients with disease progression prior to transplantation died of multidrug-resistant bacterial infections after transplantation. Conclusions:T-LBL is rare, and it is a highly aggressive tumor that predominantly occurs in adolescent males. Allogeneic hematopoietic stem cell transplantation can prolong OS, reduce relapse and improve the prognosis of patients.

OBJECTIVE To evaluate the application effect of implementation strategies in the prevention and control of sur-gical site infection(SSI),and to review its research progress.METHODS A scoping review method was employed,invol-ving systematic searches across databases such as Web of Science,PubMed,Cochrane,CNKI and Wanfang.After screening based on the inclusion and exclusion criteria,the included literature was analyzed and reported in a standard-ized manner.RESULTS A total of 47 articles were included.Most studies adopted comprehensive evidence-based practices(EBP)(≥2 types)and employed multimodal implementation strategies(≥3 items)to facilitate the implementation of SSI prevention and control EBP.Within the framework of the WHO multimodal strategy,42,39,39 and 24 studies re-spectively applied the four implementation strategies of system change,education and training,monitoring and feedback and reminder and communication,while only 9 studies applied the strategy of creating a safety culture.The highest pro-portion of studies(31.91％,15/47)employed a combination of four implementation strategies,with the common combi-nation being"system change+education and training+monitoring and feedback+reminder and communication"(29.79％,14/47),and this combination of four implementation strategies demonstrated outstanding performance in en-hancing EBP compliance.Totally 26(55.32％)showed decrease in the incidence of SSI after intervention(P＜0.05).CONCLUSIONS Implementation strategies are crucial for the successful implementation of SSI prevention and con-trol EBP.Multimodal implementation strategies are common approaches to facilitate the implementation of EBP.In the future,it is necessary to further standardize the application of scientific methods and improve the effect evaluation of im-plementation strategies,providing a reference for the sustained and widespread application of EBP in clinical practice.

Hearing loss is the most prevalent disabling disease. Cochlear implantation（CI） serves as the primary intervention for severe to profound hearing loss. This consensus systematically explores the value of genetic diagnosis in the pre-operative assessment and efficacy prognosis for CI. Drawing upon domestic and international research and clinical experience, it proposes an evidence-based medicine three-tiered prognostic classification system（Favorable, Marginal, Poor）. The consensus focuses on common hereditary non-syndromic hearing loss（such as that caused by mutations in genes like GJB2, SLC26A4, OTOF, LOXHD1） and syndromic hereditary hearing loss（such as Jervell & Lange-Nielsen syndrome and Waardenburg syndrome）, which are closely associated with congenital hearing loss, analyzing the impact of their pathological mechanisms on CI outcomes. The consensus provides recommendations based on multiple round of expert discussion and voting. It emphasizes that genetic diagnosis can optimize patient selection, predict prognosis, guide post-operative rehabilitation, offer stratified management strategies for patients with different genotypes, and advance the application of precision medicine in the field of CI.
Humans ; Cochlear Implantation ; Prognosis ; Hearing Loss/surgery* ; Consensus ; Connexin 26 ; Mutation ; Sulfate Transporters ; Connexins/genetics*

ObjectiveTo explore the mechanism and pathway of Gandou Fumu decoction （GDFMD） in the development of liver fibrosis in Wilson's disease （WD）. MethodFirst， 30 TX-j mice were randomly divided into the model group， high-dose， medium-dose， and low-dose GDFMD groups， and penicillamine group， with six mice in each group， and another six wild-type mice were used as the normal group. The high-dose， medium-dose， and low-dose GDFMD groups were intragastrically administered drugs of 13.92， 6.96， 3.48 g·kg^-1. In the penicillamine group， 0.1 g·kg^-1 of penicillamine was given by intragastric administration. The model group and the normal group were given equal volume of normal saline， once a day， for four consecutive weeks. Samples were collected four weeks after gavage， and enzyme-linked immunosorbent assay （ELISA） was used to detect type Ⅲ procollagen peptide （PCⅢ）， collagen type Ⅳ （Col Ⅳ）， hyaluronic acid （HA）， and laminin （LN）. Hematoxylin-eosin （HE）， Masson， and picric acid-Sirus red collagen （Sirus Red） staining were used to observe the histopathological changes of liver fibrosis. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）， immunohistochemistry， and Western blot were used to observe the expressions of α-smooth muscle actin （α-SMA） and collagen type Ⅰ （Col Ⅰ）， which were related to the activation of hepatic stellate cells （HSCs）. The expression of miR-29b-3p was observed by Real-time PCR. The expression of Unc-51-like kinase 1 （ULK1） and its downstream-related factors were observed by Western blot. The downstream genes of miR-29b-3p were verified by the dual luciferase reporter gene detection method. ResultCompared with the normal group， the four items of liver fibrosis （PCⅢ， Col Ⅳ， HA， and LN） in the model group were significantly abnormal （P<0.01）， and the pathology was significantly abnormal. The expression of HSC activation-related indicators including α-SMA and Col Ⅰ， as well as α-SMA mRNA and Col Ⅰ mRNA was up-regulated （P<0.05， P<0.01）， and miR-29b-3p expression was down-regulated （P<0.01）. ULK1， p-ULK1， autophagy-related gene 13 （Atg13）， p-Atg13， Beclin-1， FAK family kinase-interacting protein of 200 kDa （FIP200）， activating molecule in BECN1-regulated autophagy protein 1 （AMBKA1）， and microtubule-associated protein 1 light chain 3Ⅱ/Ⅰ（LC3Ⅱ/Ⅰ） were up-regulated （P<0.05， P<0.01）. p62 protein expression was down-regulated （P<0.01）. Compared with the model group， the four items of liver fibrosis in the high-dose， medium-dose， and low-dose GDFMD groups and the penicillamine group were significantly improve （P<0.01）， and the pathological conditions were improved. The expression of HSC activation-related indicators including α-SMA and Col Ⅰ， as well as α-SMA mRNA and Col Ⅰ mRNA was down-regulated （P<0.05， P<0.01）， and the expression of miR-29b-3p was up-regulated （P<0.01）. ULK1， p-ULK1， Atg13， p-Atg13， Beclin-1， FIP200， AMBKA1， and LC3Ⅱ/Ⅰ were down-regulated （P<0.05， P<0.01）， and p62 protein expression was up-regulated （P<0.01）. The prediction software predicted that there was a binding site between miR-29b-3p and ULK1. The dual-luciferase reporter gene detection method indicated that the luciferase activity of the ULK1-WT plasmid-transfected cell group was reduced when miR-29b-3p mimics were co-cultured （P<0.01）. ConclusionGDFMD can regulate ULK1-mediated autophagy by up-regulating miR-29b-3p and further exert its anti-hepatic fibrosis effect in Wilson's disease.