Extracellular vesicles (EV) are highly heterogeneous nanoscale vesicles secreted by cells. They carry various bioactive molecules derived from the parent cells. EV are widely distributed in various body fluids, showing enormous potential in liquid biopsy and disease treatment. However, conventional flow cytometers face challenges in detecting single EV with a diameter smaller than 300 nm. The nano-flow cytometry (nFCM) developed based on Raleigh scattering and sheath-flow single-molecule fluorescence detection has successfully pushed the detection limit of EV to 40 nm. Through multi-parameter detection at the single-particle level, nFCM enables simultaneous analysis of particle size, particle concentration, and multiple biochemical properties of individual EV. nFCM can be applied to clinical diagnosis and therapeutics based on EV.

Objective To observe the effect of oxycodone hydrochloride combined with parecoxib sodium preemptive analgesia on postoperative pain in patients undergoing gynecologic laparoscopic surgery.Methods The clinical data of patients who underwent gynecological laparoscopic surgery at the General Hospital of Huainan Oriental Hospital Group from July 2021 to February 2023 were retrospectively analyzed and the patients were divided into a control group(parecoxib sodium)and a combined group(oxycodone hydrochloride combined with parecoxib sodium)according to the different preemptive analgesic regimens.The observational indexes of this study included opioid consumption within 24 h postoperatively,visual analog scale(VAS)scores at 0,2,6,12 and 24 h postoperatively,the number of effective presses of the patient controlled analgesiac(PCA),the time of the first press of the PCA,the number of remedial analgesia,the satisfaction of analgesia,and the occurrence of postoperative adverse reactions.Results A total of 80 patients were included in the study,with 39 in the control group and 41 in the combined group.The time of the first press of the analgesic pump was significantly longer in the combined group than in the control group(P＜0.05),while the number of effective presses and sufentanil consumption were significantly lower in the combined group than in the control group(P＜0.05).The difference in the number of remedial analgesia between the two groups was not statistically significant(P＞0.05).The VAS scores at 0 h,2 h and 6 h postoperatively in the combined group were significantly lower than those in the control group(P＜0.05),and the differences between the VAS scores at 12 h and 24 h postoperatively were not statistically significant(P＞0.05).The analgesic satisfaction score of patients in the combined group was significantly higher than that of the control group(P＜0.05),and the difference in the incidence of adverse reactions was not statistically significant(P＞0.05).Conclusion The preemptive analgesia regimen of oxycodone hydrochloride combined with parecoxib sodium significantly reduced the consumption of opioid drugs in patients after gynecological laparoscopic surgery,alleviated postoperative pain,and improved patient satisfaction.

Objective:To study on anti-osteoporosis effect of different extracts of Polygoni Multiflori Radix Praeparata on zebrafish.Methods:Three kinds extracts of Polygoni Multiflori Radix Praeparata, anthraquinone and stilbene glycosides and the removal of anthraquinone and stilbene glycosides were prepared. Prednisolone was used to construct the osteoporosis model of young zebrafish. Normal control group, model group, disodium etidronate group and low-, medium- and high-dosage groups of different extracts of Polygoni Multiflori Radix Praeparata were set up. Alizarin red staining was used to investigate the mineralized skull area and bone density of juvenile zebrafish in each group. Alkaline phosphatase (AKP) and tartrate-resistant acid phosphatase (TRACP) kits were used to detect the activity of osteoblast and osteoclast enzymes in zebra larvae. The qRT PCR method was used to detect the mRNA expressions of osteoporosis related genes Runx2b, col1a2, sparc, and vdrb in each group of zebrafish.Results:Compared with model group, the skull mineralized area and bone mineral density in different extracts of Polygoni Multiflori Radix Praeparata significantly increased ( P<0.01). Polygoni Multiflori Radix Praeparata, anthraquinone and stilbene glycosides and the removal of anthraquinone and stilbene glycosides (medium- and high-dosage) could significantly increase the AKP activity of zebrafish ( P<0.01), and lower the TRAP activity of zebrafish ( P<0.01); the mRNA expression levels of Runx2b, col1a2, sparc and vdrb in juvenile zebrafish osteoporosis model were significantly up-regulated by different extracts of Polygoni Multiflori Radix Praeparata. ( P<0.01). Conclusion:Polygoni Multiflori Radix Praeparata, Anthraquinone and stilbene glycosides and the removal of anthraquinone and stilbene glycosides show better anti-osteoporosis effects. The comparison of the efficacy of three extracts from Polygonum multiflorum shows that in addition to anthraquinone and stilbene glycosides, other chemical components of Polygonum multiflorum have anti-osteoporosis effects.

Background::Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized immune-mediated disorder that can affect almost any organ in the human body. IgG4-RD can be categorized into proliferative and fibrotic subtypes based on patients’ clinicopathological characteristics. This study aimed to compare the clinical manifestations, laboratory findings, and treatment outcomes of IgG4-RD among different subtypes.Methods::We prospectively enrolled 622 patients with newly diagnosed IgG4-RD at Peking Union Medical College Hospital from March 2011 to August 2021. The patients were divided into three groups according to their clinicopathological characteristics: proliferative, fibrotic, and mixed subtypes. We compared demographic features, clinical manifestations, organ involvement, laboratory tests, and treatment agents across three subtypes. We then assessed the differences in treatment outcomes among 448 patients receiving glucocorticoids alone or in combination with immunosuppressants. Moreover, risk factors of relapse were revealed by applying the univariate and multivariate Cox regression analysis.Results::We classified the 622 patients into three groups consisting of 470 proliferative patients, 55 fibrotic patients, and 97 mixed patients, respectively. We found that gender distribution, age, disease duration, and frequency of allergy history were significantly different among subgroups. In terms of organ involvement, submandibular and lacrimal glands were frequently involved in the proliferative subtype, while retroperitoneum was the most commonly involved site in both fibrotic subtype and mixed subtype. The comparison of laboratory tests revealed that eosinophils ( P = 0.010), total IgE ( P = 0.006), high-sensitivity C-reactive protein ( P <0.001), erythrocyte sedimentation rate ( P <0.001), complement C4 ( P <0.001), IgG ( P = 0.001), IgG1 (P <0.001), IgG4 (P <0.001), and IgA ( P <0.001), at baseline were significantly different among three subtypes. Compared with proliferative and mixed subtypes, the fibrotic subtype showed the lowest rate of relapse (log-rank P = 0.014). Conclusions::Our study revealed the differences in demographic characteristics, clinical manifestations, organ involvement, laboratory tests, treatment agents, and outcomes across proliferative, fibrotic, and mixed subtypes in the retrospective cohort study. Given significant differences in relapse-free survival among the three subtypes, treatment regimens, and follow-up frequency should be considered separately according to different subtypes.Trial Registration::ClinicalTrials. gov, NCT01670695.

Objective To investigate the relationship between the expression level of miRNA Let-7 and the deletion of DNA mismatch repair(dMMR)proteins in endometrial carcinoma(EC).Methods A total of 74 patients with EC who underwent radical surgery at Lianyungang Maternal and Child Health Hospital in Jiangsu Province from May 2016 to December 2022 were selected.Immunohistochemistry was used to detect the expression of dMMR proteins(including MLH1,PMS2,MSH2,and MSH6),while real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)was performed to measure the relative expression levelof miRNA Let-7.According to the expression of dMMR proteins,EC patients were divided into the complete expression group(n=43)and the absent expression group(n=31).Logistic multivariate regression analysis was conducted to identify risk factors associated with dMMR protein deficiency,and receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of relevant factors.Results In 74 cases of EC,the expression level of miRNA Let-7 was higher in the myographic infiltration＜1/2 group than in the myographic infiltration ≥ 1/2 group,and the difference was significant(t=1.79,P=0.04).The deletion rate of dMMR protein expression was 41.89％,the deletion rate in patients aged＜55 years and miRNA Let-7 low expression group(＜0.715)were higher than those in ≥ 55 years and miRNA Let-7 high expression group(≥ 0.715),with significant differences(x2=3.92,4.50,all P＜0.05).Logistic regression analysis revealed that miRNA Let-7 expression level was an independent risk factor for dMMR expression deletion(P=0.012).Spearman correlation analysis demonstrated a negative correlation between miRNA Let-7 expression level and dMMR protein deletion(r=-0.247,P=0.034).ROC curve analysis indicated that the expression level of miRNA Let-7 had a certain predictive value for dMMR protein deletion in EC patients,with an AUC of 0.737,an optimal critical value of 0.77,a sensitivity and a specificity of 0.651 and 0.806,respectively.Conclusion The expression level of miRNA Let-7 was correlated with the deletion of dMMR proteins in patients diagnosed with EC.Moreover,it served as a potential risk factor for dMMR protein deficiency.It may offer valuable insights into predicting dMMR expression deletion.

Objective:To study the protective effects and mechanism of Melastoma sanguineum Sims fruit extract (MSE) on chronic chemical liver injury induced by ethanol, acetaminophen and carbon tetrachloride in mice; To discuss it mechanism.Methods:Totally 96 mice were divided into normal control group, ethanol model group, ethanol+bifendate control group and ethanol+MSE high-, medium- and low-dosage groups, APAP model group, APAP+bifendate control group and APAP+MSE high-, medium- and low-dosage groups, CCl 4 model group, CCl 4+bifendate control group and CCl 4+MSE high-, medium- and low-dosage groups, with 6 mice in each group. Except for the normal control group, the other groups were respectively prepared for the ethanol model, the APAP model and the CCl 4 model. The mice in the MSE high-, medium- and low-dosage groups were intragastrically administrated with 10, 5 and 2.5 g/kg of MSE, respectively; the bifendate control group was intraperitoneally injected with 15 mg/ml bifendate solution at 75 mg/kg; the normal control group was intraperitoneally injected with equal volume of normal saline/peanut oil solution once a day for 25 consecutive days. The levels of GPT, GOT and total bilirubin (TBIL) in serum were detected; the activities of SOD and GSH-Px and the content of MDA in liver tissue were detected; the mRNA expressions of TNF-α, IL-6, alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase (ALDH) were detected by qRT-PCR; the protein expressions of cytochrome P450 CYP1A1, CYP1A2, and CYP3A in liver tissue were detected by Western blot; the pathological changes of the liver tissue were observed by HE staining. Results:Compared with the corresponding ethanol, APAP and CCl 4 model groups, the serum GPT, GOT and TBIL levels of mice in the ethanol+bifendate control group and ethanol+MSE high- and medium-dosage groups, the APAP+bifendate control group and APAP+MSE high- and medium-dosage groups, and the CCl 4+bifendate control group and CCl 4+MSE high- and medium-dosage groups decreased ( P<0.01 or P<0.05), the activities of SOD and GSH-Px in the liver tissue increased ( P<0.01 or P<0.05), and the MDA level decreased ( P<0.01 or P<0.05), and the mRNA levels of IL-6 and TNF-α decreased ( P<0.01); the mRNA levels of ADH and ALDH in the ethanol+MSE high-, medium-, and low-dosage groups decreased ( P<0.01). Compared with the APAP model group, the expressions of CYP1A1 and CYP1A2 in the APAP+MSE groups increased ( P<0.01), and the expression of CYP3A protein decreased ( P<0.05); compared with the CCl 4 model group, the expressions of CYP1A1, CYP1A2 and CYP3A proteins in the CCl 4+MSE groups decreased ( P<0.05). Conclusion:MSE has a protective effect on chronic chemically-induced liver injury induced by ethanol, APAP, and CCl 4 in mice, and its mechanism may be related to antioxidant stress, inhibition of inflammatory response, and regulation of the expression of cytochrome P450-related enzymes.

Objective:To investigate the application of objective-based teaching combined with Roy adaptive situational teaching in emergency nursing teaching.Methods:A total of 110 nursing students who were assigned to Emergency Department of Xijing Hospital, The First Affiliated Hospital of Air Force Medical University, as interns were selected and divided into control group and observation group according to the order of admission, with 55 students in each group. The students in the control group received traditional teaching, while those in the observation group received objective-based teaching combined with Roy adaptive situational teaching. The two groups were evaluated in terms of the assessment score of situational simulation and the ability for emergency medicine and treatment. SPSS 22.0 was used to perform the t-test and the chi-square test. Results:For the nursing students in the observation group, the mean scores of theoretical knowledge objective, skill objective, and attitude objective were (9.09±1.21) points, (13.98±1.87) points, and (9.32±0.95) points, respectively, and for those in the control group, the mean scores of these objectives were (8.41±1.17) points, (12.43±1.72) points, and (8.72±0.83) points, respectively, suggesting that compared with the control group, the observation group had a significantly higher mastery degree of the teaching objectives (theoretical knowledge objective, skill objective, and attitude objective) ( P < 0.05). The observation group had significantly better abilities for emergency medicine and treatment than the control group ( P < 0.05). Conclusion:Objective-based teaching combined with Roy adaptive situational teaching can be used in emergency nursing teaching and may help to improve the theoretical and practical skills of nursing students and cultivate the abilities for emergency medicine and treatment.

Objective:To analyze post-discharge coping difficulty of delivery women based on social ecosystem theory.Methods:From March to May 2022, 23 delivery women from Affiliated Hospital of Guilin Medical University were selected as research objects by the purpose sampling method. The phenomenological research method was used to conduct face-to-face semi-structured interview. The content analysis method was used to analyze the data and extract the theme.Results:A total of 3 themes and 11 sub-themes were extracted. The micro level included 1 theme, namely care stress and self recovery problems coexist, including difficulty in breastfeeding, feeling powerless to raise children, anxiety, disturbance in body recovery of delivery women, prominent sense of sleep deprivation, insufficient knowledge of infant care and body recovery. The mesoscopic level included 1 theme, namely changes in life atmosphere, including caregiver relationship conflict, lack of family support and sense of connection. The macro level included 1 theme, namely interaction of social environment, including living environment not meeting expectations, sense of economic burden, expectation of instant professional guidance.Conclusions:The post-discharge coping difficulty of delivery women is complex and varied. Medical staff should use information technology, family synchronous empowerment, social worker intervention and other methods to meet the needs of delivery women, reduce their post-discharge coping difficulties.

Objective:To analyze the efficacy of nutrition intervention combined with rehabilitation exercise in elderly patients with chronic heart failure (CHF) complicated by sarcopenia.Methods:In this randomized controlled trial, seventy CHF patients with sarcopenia, aged 80 years or older, who had received standard CHF medication treatment and had stable conditions with preserved ejection fraction (HFpEF) from June 2021 to October 2022 at the China-Japan Friendship Hospital outpatient clinic were continuously selected. The patients were randomly divided into a test group ( n=35) and a control group ( n=35) using a random number table. The test group continued the original heart failure medication treatment, and on the basis of daily meal, supplemented with whey protein powder [37 g per serving (including 16.2 g of whey protein, 145 kcal), twice a day]; they were given resistance exercise primarily focused on resistance training (5 sets of exercises, progressively increasing to 3 days per week, twice a day, 5 sets per session, 20 repetitions per set). The control group maintained the original heart failure medication treatment plan and lifestyle. The body mass index, appendicular skeletal muscle mass index (ASMI), grip strength, Five-Times-Sit-to-Stand Test, 6-meter walking speed, 6-minute walk test, brain natriuretic peptide (BNP), left ventricular ejection fraction, ratio of early mitral flow peak velocity to early mitral annulus diastolic peak velocity (E/e′), serum albumin, hemoglobin, and serum creatinine were compared between the two groups before and after 3 months of intervention using t-tests and chi-square tests to analyze the efficacy of nutrition intervention combined with rehabilitation exercise in elderly patients with CHF complicated by sarcopenia. Results:Among the 70 patients, there were 42 males and 28 females. There was no significant difference in baseline data between the test group and the control group (all P>0.05). After 3 months of intervention, ASMI, grip strength and 6 min walking distance in the test group were all significantly higher than those in the control group [(6.43±1.07) vs (6.09±0.86) kg/m 2, (27.75±2.13) vs (23.45±0.47) kg, (361.51±58.71) vs (273.50±69.85) m], and significantly higher than those before intervention [(5.99±1.45) kg/m 2, (23.55±9.64) kg, (273.50±69.86) m]. The time of Five-Times-Sit-to-Stand Test, BNP and E/e′ in the test group were both significantly lower than those in the control group [(11.20±2.09) vs (15.36±0.46) s, (278.80±58.69) vs (400.80±87.86) ng/L, (11.10±0.81) vs (14.66±1.90)], and significantly lower than those before intervention [(18.51±2.90) s, (407.50±122.74) ng/L and (14.00±1.15)]. There was no significant difference in remaining indicators between the two groups (all P>0.05). Conclusion:Nutritional intervention combined with rehabilitation exercise primarily focused on whey protein supplementation and resistance training can significantly improve limb muscle mass, muscle strength, muscle function, and cardiac function in elderly patients with CHF complicated by sarcopenia on the basis of heart failure medication treatment.

IgG 4-related disease (IgG 4-RD) is an immune-mediated fibroinflammatory condition characterized by tumefactive lesions in multi-organs. It is a novel entity presented by variable manifestations. In recent years, there has been progress toward recognizing IgG 4-RD. However, the diagnosis and treatment of IgG 4-RD still present challenges due to insufficient experience. To address this, the Chinese Rheumatology Association has developed standardized guidelines for the diagnosis and treatment of IgG 4-RD based on domestic and international experience. These guidelines aim to enhance the understanding and management of IgG 4-RD, ultimately improving the prognosis for patients with IgG 4-RD.