Background: Diabetic pain patients have increased pain at night. Exosomes can relieve neuropathic pain. This study aimed to investigate the efficacy of exosome administration at different time points in relieving diabetic neuropathic pain (DNP) in rats. Methods: M2 macrophages from bone marrow were induced in mice and exosomes were extracted. A diabetic rat model was induced using streptozotocin, with the mechanical withdrawal threshold (MWT) of the rats beingmeasured at ≤ 80% of the basal value after 14 days, indicating successful construction of the DNP rat model.Exosomes were administered on three consecutive days at ZT0 (zeitgeber time) and ZT12. Parameters including blood glucose levels, body weight, MWT, and thermal withdrawal latency (TWL) were assessed in the rats. The lumbar spinal cord of rats was examined on days 21 and 28 to measure inflammatory factors and observe the expression of M1 and M2 microglia. Furthermore, microglia were exposed to lipopolysaccharide (LPS) and LPS + exosomes in a controlled in vitro setting to assess alterations in microglia phenotype involving the NF-kB p65 andIKBα inflammatory signaling pathways. Results: The findings revealed that administration of exosomes during the rat resting period at ZT12 resulted in increased MWT and TWL, as well as a shift in microglia polarization towards the M2 phenotype. In vitro analysis indicated that exosomes influenced microglia polarization and suppressed the phosphorylation of NF-kB p65 andIKBα.  Conclusions Temporal therapy with exosomes effectively reduces pain in DNP rats by polarizing microglia andaffecting NF-kB p65 and IKBα signaling pathways.

Background: Diabetic pain patients have increased pain at night. Exosomes can relieve neuropathic pain. This study aimed to investigate the efficacy of exosome administration at different time points in relieving diabetic neuropathic pain (DNP) in rats. Methods: M2 macrophages from bone marrow were induced in mice and exosomes were extracted. A diabetic rat model was induced using streptozotocin, with the mechanical withdrawal threshold (MWT) of the rats beingmeasured at ≤ 80% of the basal value after 14 days, indicating successful construction of the DNP rat model.Exosomes were administered on three consecutive days at ZT0 (zeitgeber time) and ZT12. Parameters including blood glucose levels, body weight, MWT, and thermal withdrawal latency (TWL) were assessed in the rats. The lumbar spinal cord of rats was examined on days 21 and 28 to measure inflammatory factors and observe the expression of M1 and M2 microglia. Furthermore, microglia were exposed to lipopolysaccharide (LPS) and LPS + exosomes in a controlled in vitro setting to assess alterations in microglia phenotype involving the NF-kB p65 andIKBα inflammatory signaling pathways. Results: The findings revealed that administration of exosomes during the rat resting period at ZT12 resulted in increased MWT and TWL, as well as a shift in microglia polarization towards the M2 phenotype. In vitro analysis indicated that exosomes influenced microglia polarization and suppressed the phosphorylation of NF-kB p65 andIKBα.  Conclusions Temporal therapy with exosomes effectively reduces pain in DNP rats by polarizing microglia andaffecting NF-kB p65 and IKBα signaling pathways.

Background: Diabetic pain patients have increased pain at night. Exosomes can relieve neuropathic pain. This study aimed to investigate the efficacy of exosome administration at different time points in relieving diabetic neuropathic pain (DNP) in rats. Methods: M2 macrophages from bone marrow were induced in mice and exosomes were extracted. A diabetic rat model was induced using streptozotocin, with the mechanical withdrawal threshold (MWT) of the rats beingmeasured at ≤ 80% of the basal value after 14 days, indicating successful construction of the DNP rat model.Exosomes were administered on three consecutive days at ZT0 (zeitgeber time) and ZT12. Parameters including blood glucose levels, body weight, MWT, and thermal withdrawal latency (TWL) were assessed in the rats. The lumbar spinal cord of rats was examined on days 21 and 28 to measure inflammatory factors and observe the expression of M1 and M2 microglia. Furthermore, microglia were exposed to lipopolysaccharide (LPS) and LPS + exosomes in a controlled in vitro setting to assess alterations in microglia phenotype involving the NF-kB p65 andIKBα inflammatory signaling pathways. Results: The findings revealed that administration of exosomes during the rat resting period at ZT12 resulted in increased MWT and TWL, as well as a shift in microglia polarization towards the M2 phenotype. In vitro analysis indicated that exosomes influenced microglia polarization and suppressed the phosphorylation of NF-kB p65 andIKBα.  Conclusions Temporal therapy with exosomes effectively reduces pain in DNP rats by polarizing microglia andaffecting NF-kB p65 and IKBα signaling pathways.

Background: Diabetic pain patients have increased pain at night. Exosomes can relieve neuropathic pain. This study aimed to investigate the efficacy of exosome administration at different time points in relieving diabetic neuropathic pain (DNP) in rats. Methods: M2 macrophages from bone marrow were induced in mice and exosomes were extracted. A diabetic rat model was induced using streptozotocin, with the mechanical withdrawal threshold (MWT) of the rats beingmeasured at ≤ 80% of the basal value after 14 days, indicating successful construction of the DNP rat model.Exosomes were administered on three consecutive days at ZT0 (zeitgeber time) and ZT12. Parameters including blood glucose levels, body weight, MWT, and thermal withdrawal latency (TWL) were assessed in the rats. The lumbar spinal cord of rats was examined on days 21 and 28 to measure inflammatory factors and observe the expression of M1 and M2 microglia. Furthermore, microglia were exposed to lipopolysaccharide (LPS) and LPS + exosomes in a controlled in vitro setting to assess alterations in microglia phenotype involving the NF-kB p65 andIKBα inflammatory signaling pathways. Results: The findings revealed that administration of exosomes during the rat resting period at ZT12 resulted in increased MWT and TWL, as well as a shift in microglia polarization towards the M2 phenotype. In vitro analysis indicated that exosomes influenced microglia polarization and suppressed the phosphorylation of NF-kB p65 andIKBα.  Conclusions Temporal therapy with exosomes effectively reduces pain in DNP rats by polarizing microglia andaffecting NF-kB p65 and IKBα signaling pathways.

Background: Diabetic pain patients have increased pain at night. Exosomes can relieve neuropathic pain. This study aimed to investigate the efficacy of exosome administration at different time points in relieving diabetic neuropathic pain (DNP) in rats. Methods: M2 macrophages from bone marrow were induced in mice and exosomes were extracted. A diabetic rat model was induced using streptozotocin, with the mechanical withdrawal threshold (MWT) of the rats beingmeasured at ≤ 80% of the basal value after 14 days, indicating successful construction of the DNP rat model.Exosomes were administered on three consecutive days at ZT0 (zeitgeber time) and ZT12. Parameters including blood glucose levels, body weight, MWT, and thermal withdrawal latency (TWL) were assessed in the rats. The lumbar spinal cord of rats was examined on days 21 and 28 to measure inflammatory factors and observe the expression of M1 and M2 microglia. Furthermore, microglia were exposed to lipopolysaccharide (LPS) and LPS + exosomes in a controlled in vitro setting to assess alterations in microglia phenotype involving the NF-kB p65 andIKBα inflammatory signaling pathways. Results: The findings revealed that administration of exosomes during the rat resting period at ZT12 resulted in increased MWT and TWL, as well as a shift in microglia polarization towards the M2 phenotype. In vitro analysis indicated that exosomes influenced microglia polarization and suppressed the phosphorylation of NF-kB p65 andIKBα.  Conclusions Temporal therapy with exosomes effectively reduces pain in DNP rats by polarizing microglia andaffecting NF-kB p65 and IKBα signaling pathways.

BACKGROUND:Much of the current research on M2 macrophage-derived exosomes focuses on their effects on wound healing and osteoblast proliferation and differentiation,while few studies have focused on their role in regulating microglia phenotype.OBJECTIVE:To discuss the role and molecular mechanisms of M2 macrophage-derived exosomes in the phenotypic regulation of microglia.MERHODS:(1)Bone marrow primary macrophages were extracted and then stimulated with 50 ng/mL interleukin 4 for 24 hours to promote macrophage M2-type polarization.Flow cytometry and cellular immunofluorescence were used to identify the M2-type macrophage marker CD206.(2)M2 macrophage-derived exosomes were extracted and identified.(3)Microglia BV2 were randomly divided into three groups:control group,lipopolysaccharide group,and treatment group.No treatment was done in the control group.500 ng/mL lipopolysaccharide was added to the intervention for 24 hours in the lipopolysaccharide group.500 ng/mL lipopolysaccharide and 25 μg/mL M2 macrophage-derived exosomes were added simultaneously to the treatment group for 24 hours.ELISA was performed to detect the secretion of tumor necrosis factor α and interleukin 10 in the culture supernatant.qRT-PCR was performed to detect the mRNA expression of inducible nitric oxide synthase,arginase 1,interleukin 1β,and interleukin 10 in the cells.Western blot assay was performed to detect the protein expression of inducible nitric oxide synthase,arginase 1,and nuclear factor-κB signaling pathway related protein expression.RESULTS AND CONCLUSION:(1)ELISA results showed that the secretion of tumor necrosis factor α was significantly increased in the lipopolysaccharide group compared with the control group.The secretion of tumor necrosis factor α was reduced and the secretion of interleukin 10 was increased in the treatment group compared with the lipopolysaccharide group.(2)The qRT-PCR results showed that compared with the control group,the mRNA expression of interleukin 1β and inducible nitric oxide synthase increased in the lipopolysaccharide group.Compared with the lipopolysaccharide group,the mRNA expression of interleukin 1β and inducible nitric oxide synthase decreased,and the mRNA expression of interleukin 10 and arginase 1 increased in the treatment group.(3)Western blot assay results showed that the expression of inducible nitric oxide synthase protein was increased in the lipopolysaccharide group compared with the control group.The expression of inducible nitric oxide synthase protein was decreased and the expression of arginase 1 protein was elevated in the treatment group compared with the lipopolysaccharide group.(4)Compared with the control group,the expression of p65 and p-IκB-α proteins in the nuclear factor-κB signaling pathway was reduced in the lipopolysaccharide group,whereas the expression of p65 and p-IκB-α proteins was elevated in the treatment group compared with the lipopolysaccharide group.The results showed that M2-type macrophage-derived exosomes could significantly inhibit lipopolysaccharide-induced inflammatory responses in microglia,enhance the expression of the anti-inflammatory factor interleukin 10,suppress the expression of the pro-inflammatory factors tumor necrosis factor α and interleukin 1β,and promote microglial cell phenotypes polarized from the M1-type to the M2-type.The mechanism may be related to the inhibition of nuclear factor-κB signaling pathway activation by M2-type macrophage-derived exosomes.

Objective Compare the efficacy and safety of Transcatheter Aortic Valve Replacement(ViV TAVR)versus Secondary Surgical Aortic Valve Replacement(redo SAVR)in patients with structural valve deterioration.Methods A retrospective analysis of clinical data was performed on 61 patients with valve failure who underwent ViV TAVR or redo SAVR treatment at the hospital between January 2020 and June 2022.Based on the differing treatment modalities,the patients were categorized into two groups:the ViV TAVR group(n=31)and the redo SAVR group(n=30).The study compared perioperative-related indicators(surgical time,hospital stay duration,mechanical ventilation time,and intensive care unit observation period),echocardiographic parameters at four time points:preoperatively(T1),1 month postoperatively(T2),3 months postoperatively(T3),and 6 months postoperatively(T4),as well as primary and secondary endpoint events.Results The ViV-TAVR group had shorter operation time and hospital stay,and less extracorporeal circulation assistance compared to the redo-SAVR group,with statistically significant differences(P<0.05).Intra-group comparisons showed that at 1 month(T2),3 months(T3),and 6 months(T4)after surgery,the left ventricular ejection fraction(LVEF),aortic valve peak flow velocity(AVmax),peak transvalvular pressure gradient(PGmax),and PGmean in both groups were lower than those at the preoperative(T1)time point.At T3 and T4,the left ventricular end-diastolic diameter(LVEDD)in both groups was lower than that at T1 and T2,with statistically significant differences(P<0.05).The mortality rate within 30 days in the ViV-TAVR group was lower than that in the redo-SAVR group,with a statistically significant difference(P<0.05).However,there was no statistically significant difference in all-cause mortality within 24 months between the two groups(P>0.05).The incidence of acute renal failure in the ViV-TAVR group was lower than that in the redo-SAVR group,with a statistically significant difference(P<0.05).Conclusion Compared with redo SAVR,ViV TAVR not only significantly decreases the 30-day mortality risk and the incidence of acute renal failure in patients with bioprosthetic valve dysfunction but also demonstrates comparable long-term mortality rates to redo SAVR.

Objective Compare the efficacy and safety of Transcatheter Aortic Valve Replacement(ViV TAVR)versus Secondary Surgical Aortic Valve Replacement(redo SAVR)in patients with structural valve deterioration.Methods A retrospective analysis of clinical data was performed on 61 patients with valve failure who underwent ViV TAVR or redo SAVR treatment at the hospital between January 2020 and June 2022.Based on the differing treatment modalities,the patients were categorized into two groups:the ViV TAVR group(n=31)and the redo SAVR group(n=30).The study compared perioperative-related indicators(surgical time,hospital stay duration,mechanical ventilation time,and intensive care unit observation period),echocardiographic parameters at four time points:preoperatively(T1),1 month postoperatively(T2),3 months postoperatively(T3),and 6 months postoperatively(T4),as well as primary and secondary endpoint events.Results The ViV-TAVR group had shorter operation time and hospital stay,and less extracorporeal circulation assistance compared to the redo-SAVR group,with statistically significant differences(P<0.05).Intra-group comparisons showed that at 1 month(T2),3 months(T3),and 6 months(T4)after surgery,the left ventricular ejection fraction(LVEF),aortic valve peak flow velocity(AVmax),peak transvalvular pressure gradient(PGmax),and PGmean in both groups were lower than those at the preoperative(T1)time point.At T3 and T4,the left ventricular end-diastolic diameter(LVEDD)in both groups was lower than that at T1 and T2,with statistically significant differences(P<0.05).The mortality rate within 30 days in the ViV-TAVR group was lower than that in the redo-SAVR group,with a statistically significant difference(P<0.05).However,there was no statistically significant difference in all-cause mortality within 24 months between the two groups(P>0.05).The incidence of acute renal failure in the ViV-TAVR group was lower than that in the redo-SAVR group,with a statistically significant difference(P<0.05).Conclusion Compared with redo SAVR,ViV TAVR not only significantly decreases the 30-day mortality risk and the incidence of acute renal failure in patients with bioprosthetic valve dysfunction but also demonstrates comparable long-term mortality rates to redo SAVR.

BACKGROUND:Much of the current research on M2 macrophage-derived exosomes focuses on their effects on wound healing and osteoblast proliferation and differentiation,while few studies have focused on their role in regulating microglia phenotype.OBJECTIVE:To discuss the role and molecular mechanisms of M2 macrophage-derived exosomes in the phenotypic regulation of microglia.MERHODS:(1)Bone marrow primary macrophages were extracted and then stimulated with 50 ng/mL interleukin 4 for 24 hours to promote macrophage M2-type polarization.Flow cytometry and cellular immunofluorescence were used to identify the M2-type macrophage marker CD206.(2)M2 macrophage-derived exosomes were extracted and identified.(3)Microglia BV2 were randomly divided into three groups:control group,lipopolysaccharide group,and treatment group.No treatment was done in the control group.500 ng/mL lipopolysaccharide was added to the intervention for 24 hours in the lipopolysaccharide group.500 ng/mL lipopolysaccharide and 25 μg/mL M2 macrophage-derived exosomes were added simultaneously to the treatment group for 24 hours.ELISA was performed to detect the secretion of tumor necrosis factor α and interleukin 10 in the culture supernatant.qRT-PCR was performed to detect the mRNA expression of inducible nitric oxide synthase,arginase 1,interleukin 1β,and interleukin 10 in the cells.Western blot assay was performed to detect the protein expression of inducible nitric oxide synthase,arginase 1,and nuclear factor-κB signaling pathway related protein expression.RESULTS AND CONCLUSION:(1)ELISA results showed that the secretion of tumor necrosis factor α was significantly increased in the lipopolysaccharide group compared with the control group.The secretion of tumor necrosis factor α was reduced and the secretion of interleukin 10 was increased in the treatment group compared with the lipopolysaccharide group.(2)The qRT-PCR results showed that compared with the control group,the mRNA expression of interleukin 1β and inducible nitric oxide synthase increased in the lipopolysaccharide group.Compared with the lipopolysaccharide group,the mRNA expression of interleukin 1β and inducible nitric oxide synthase decreased,and the mRNA expression of interleukin 10 and arginase 1 increased in the treatment group.(3)Western blot assay results showed that the expression of inducible nitric oxide synthase protein was increased in the lipopolysaccharide group compared with the control group.The expression of inducible nitric oxide synthase protein was decreased and the expression of arginase 1 protein was elevated in the treatment group compared with the lipopolysaccharide group.(4)Compared with the control group,the expression of p65 and p-IκB-α proteins in the nuclear factor-κB signaling pathway was reduced in the lipopolysaccharide group,whereas the expression of p65 and p-IκB-α proteins was elevated in the treatment group compared with the lipopolysaccharide group.The results showed that M2-type macrophage-derived exosomes could significantly inhibit lipopolysaccharide-induced inflammatory responses in microglia,enhance the expression of the anti-inflammatory factor interleukin 10,suppress the expression of the pro-inflammatory factors tumor necrosis factor α and interleukin 1β,and promote microglial cell phenotypes polarized from the M1-type to the M2-type.The mechanism may be related to the inhibition of nuclear factor-κB signaling pathway activation by M2-type macrophage-derived exosomes.

Objective To investigate the serum levels of semaphorin 3E(Sema3E)in patients with intracranial aneurysms,revealing the correlation between Sema3E and 1-month poor prognosis after interventional embolization.Methods This study was a prospective single-center cohort study,recruiting 102 consecutive patients with intracranial aneurysms who underwent interventional surgery from June 2020 to January 2022 in our hospital.Among them,11 patients were excluded.Clinical and radiological profiles were collected.Peripheral blood was collected after admission,and serum Sema3E levels were determined by enzyme-linked immunosorbent assay.All the aneurysms were treated with endovascular coil embolization or stent-assisted coil embolization.The primary outcome was evaluated with the Glasgow Outcome Scale(GOS)1 month after interventional therapy.The favorable outcome was defined as a GOS score of 4-5,and a poor outcome was defined as a GOS score of 1-3(severe disability,vegetative state,or death).Univariate and multivariate logistic regression analyses were used to identify potential prognostic factors after interventional therapy.Results The average age of 91 patients with intracranial aneurysm was 59.9±11.0 years old,including 70 cases(76.9%)with favorable prognosis and 21 cases(23.1%)with poor prognosis.The mean preoperative Glasgow Coma Scale(GCS)score of the poor prognosis group(9.4±4.5)was significantly lower than that of the favorable prognosis group(13.3±2.5;P<0.001).In the poor prognosis group,the Hunt-Hess grade(3.6±0.6 vs.2.0±1.3,P<0.001)and the serum Sema3E levels[(6.21±1.58)μg/L vs.(4.38±1.77)μg/L,P<0.001]were significantly higher than those in the favorable prognosis group.Logistic regression analysis showed the Hunt-Hess grade(OR =7.150,P =0.003),stent-assisted coil embolization(OR =15.777,P =0.010),and the serum Sema3E level(OR =1.756,P =0.027)were independent prognostic factors for intracranial aneurysms after interventional therapy.Conclusions The serum Sema3E level is closely correlated with the severity of intracranial aneurysms.The serum Sema3E level is a prognostic factor for interventional treatment,which can be used as a biomarker for predicting poor outcomes.