BACKGROUND:The formation of postoperative abdominal adhesions is a complicated process,and the prevention of postoperative adhesions is an urgent problem in clinic. OBJECTIVE:To analyze the mechanism of adhesion at cellular and molecular levels,and to provide theoretical basis for the prevention and treatment of adhesion by mesenchymal stem cell exosomes. METHODS:"Abdominal adhesion,pelvic adhesion,postoperative adhesion,epithelial mesenchymal transformation,mesenchymal stem cells,stem cell exosomes,mesenchymal stem cell exosomes"were selected as Chinese and English search terms.We searched PubMed,CNKI,and Chinese biomedical literature and screened relevant articles on postoperative abdominal adhesion and mesenchymal stem cell exosomal intervention published from inception to August 2023.After systematic analysis,54 articles were finally included for the review. RESULTS AND CONCLUSION:(1)Any pathological factors such as peritoneal inflammation,mechanical injury,tissue ischemia,and foreign body implantation cause peritoneal surface injury,resulting in postoperative abdominal adhesion.The formation process of adhesion includes the interaction of peritoneal mesothelial cell repair,inflammatory response,fibrinolytic system,coagulation pathway and other processes,involving a variety of cytokines and signaling pathways.Wnt/β-catenin pathway can induce fibrosis and angiogenesis,and cooperate with transforming growth factor-β/Smads signaling pathway to stimulate fibroblast proliferation and cause peritoneal fibrosis.Meanwhile,nuclear factor-κB signaling pathway up-regulates the expression of cellular inflammatory factors,promotes fibroblast proliferation,and plays a key role in the process of tissue fibrosis.(2)The paracrine function of stem cells is an important direction of molecular intervention in abdominal adhesions based on regenerative medicine.It can participate in a variety of complex cytokines and signaling pathways involved in abdominal adhesions.(3)Compared with traditional methods for treating abdominal adhesions,mesenchymal stem cell exosome has biological activity and is safe to use.Mesenchymal stem cell exosomes without special culture and expansion have lower immunogenicity,longer stability and other advantages,can guide a normal repair and healing through a variety of ways.(4)Mesenchymal stem cell exosome has been proven to be involved in regulating the above processes of adhesion formation in previous studies,showing potential application prospects in clinical studies.However,further clinical studies are needed to explore appropriate treatment options for mesenchymal stem cell exosomes to address the problem of clinical translation.

Aim To investigate the mechanism of ultra-fine garlic powder(UGP)in ameliorating dyslipidemia and aortic inflammation and fibrosis in atherosclerotic(AS)mice.Methods A 10-week ApoE-/-mouse AS model was constructed,cardiac index was meas-ured,and aortic histopathological changes were ob-served by oil red O staining.Serum inflammatory factor levels were detected by ELISA,and the expression of JNK,NF-κB,ERK and their phosphorylated proteins were detected by Western blot.Results Cardiac in-dex and other indicators as well as aortic lesions were worsened in the AS group,as compared with the normal control group.Compared with the AS group,the UGP treatment group and the traditional garlic grinding pow-der(TGP)treatment group significantly decreased total cholesterol(TC),triglyceride(TG),low-density lipo-protein cholesterol(LDL-C),atherosclerosis index(AI1,AI2),and coronary cardiac index and restored high-density lipoprotein cholesterol(HDL-C)levels,and the area of aortic lesions,inflammation and fibrosis were significantly improved,and at the same time,sig-nificantly inhibited the expression of TNF-α,IL-1β,and IL-6,as well as the expression of p-JNK,p-NF-κB and p-ERK proteins.The therapeutic effect of the UGP group was superior to that of the TGP group.Conclu-sion UGP can significantly inhibit the formation of aortic endothelial AS plaques,reduce the levels of in-flammation and fibrosis,and regulate blood lipids in a-orta of AS mice.

Objective:To explore the predictive value of platelet aggregation function for acute kidney injury (AKI) in sepsis patients based on decision curve.Methods:A retrospective study was conducted to collect and analyze the clinical data of 120 sepsis patients admitted to the Affiliated Hospital of Jiangnan University from January 2021 to December 2023. According to the incidence of AKI during hospitalization, they were divided into AKI group (37 cases) and non-AKI group (83 cases). The general data, platelet aggregation function index (platelet aggregation rate) and other laboratory indexes of the two groups were collected and compared. Logistic regression model was used to analyze the relationship between AKI and main indexes of platelet aggregation function in patients with sepsis. The area under the curve (AUC) was obtained by drawing the receiver operating characteristic (ROC) curve, and the predictive value of platelet aggregation function on AKI in patients with sepsis was analyzed. R language software was used to construct a nomogram model of platelet aggregation function combined with other main indicators to predict AKI in patients with sepsis. Based on the decision curve, the predictive efficacy of the model on AKI in patients with sepsis was analyzed.Results:The platelet aggregation rate in the AKI group was lower than that in the non-AKI group: (56.23 ± 7.86)% vs. (68.79 ± 8.54)%, and the thrombin time was longer than that in the non-AKI group: 17.00 (16.50, 18.00) s vs. 16.00 (15.00, 17.00) s. The levels of D-dimer, C-reactive protein and procalcitonin were higher than those in the non-AKI group: (1.55 ± 0.45) mg/L vs. (1.32 ± 0.41) mg/L, (107.53 ± 18.41) mg/L vs. (99.86 ± 17.25) mg/L, (3.10 ± 0.46) μg/L vs. (2.88 ± 0.42) μg/L, and the differences were statistically significant ( P<0.05). The results of constructing a Logistic regression model showed that AKI in sepsis patients may be related to abnormal levels of platelet aggregation rate, thrombin time, C-reactive protein and procalcitonin ( P<0.05). The ROC curve was drawn to obtain the corresponding AUC: the AUC of platelet aggregation rate predicting sepsis complicated with AKI was 0.860 (95% CI 0.789 to 0.931), which had certain predictive value. When the platelet aggregation rate was set to 62.84%, the best predictive value can be obtained, with sensitivity, specificity, and Jorden index of 83.80%, 80.70%, and 0.645, respectively. The nomogram model of platelet aggregation function assisting other major indicators in predicting AKI in sepsis patients had a C-index of 0.904 (95% CI 0.851 to 0.957), indicating good discrimination of the model. Through decision curve analysis of the clinical net benefit of the model, the results showed that the clinical net benefit of the model was higher than that of platelet aggregation rate and other major indicators when applied alone. When the risk threshold was within the range of 0 to 0.81 and 0.97 to 1.00, the model could provide a significant increase in clinical net benefit rate. Conclusions:Platelet aggregation function (platelet aggregation rate) can serve as an early auxiliary predictive indicator for the risk of AKI in sepsis patients, and can assist other major indicators to improve the predictive value of AKI in sepsis patients.

Objective To evaluate the correlation between soluble programmed cell death-ligand 1(PD-L1)and clinical features of patients with unstable angina pectoris(UAP),and analyze its correlation with prognosis.Methods A total of 171 UAP patients treated in our hospital from April 2021 to October 2023 were recruited retrospectively,and according to adverse cardiovascular events occurred or not within 6 months of follow-up,they were divided into good prognosis group(137 cases)and poor prognosis group(34 cases).Fasting venous blood sample of 4 ml was collect-ed to detect the levels of soluble PD-L1,LDL-C,HDL-C,hs-CRP,hs-cTnI,IL-6,IL-10 and TNF-α.Pearson correlation analysis was used to analyze the correlation between soluble PD-L1 level and clinical features of the UAP patients,and logistic regression model was employed to evaluate the correlation between soluble PD-L1 and the occurrence of adverse cardiovascular events in the UAP patients.ROC curve analysis was applied to evaluate its performance in predicting the clini-cal prognosis,and its AUC value was calculated.Results The poor prognosis group had signifi-cantly lower LDL-C level and LVEF value,but higher levels of HDL-C,hs-CRP,hs-cTnI,IL-6,IL-10,TNF-α and soluble PD-L1 than the good prognosis group(P＜0.05,P＜0.01).Pearson cor-relation analysis showed that soluble PD-L1 level was positively correlated with hs-CRP level(r=0.502,P=0.000).Multivariate logistic regression analysis indicated that the levels of hs-CRP,hs-cTnI and soluble PD-L1 were independent influencing factors for major cardiovascular adverse events in the UAP patients(OR=2.872,95％CI:1.069-7.717,P=0.036;OR=1.667,95％CI:1.022-2.717,P=0.040;OR=1.152,95％CI:1.023-1.297,P=0.019).ROC curve anal-ysis revealed that soluble PD-L1 had high predictive value for clinical prognosis of UAP patients,with an AUC value of 0.942,a sensitivity of 82.35％and a specificity of 94.16％.Conclusion The increased level of soluble PD-L1 increases the risk of major adverse cardiovascular events in UAP patients.Soluble PD-L1 can be used as a potential new biomarker to predict the clinical prognosis of patients.

Objective To evaluate the efficacy and safety of polyethylene glycol electrolyte powder(PEG)combined with linaclotide(Lin)for bowel preparation in elderly constipated patients before colonoscopy.Methods In this prospective,randomized controlled trial,90 elderly patients with constipation undergoing colonoscopy were recruited at our hospital from June 2022 to December 2023.Participants were randomly assigned to three groups(n=30 each):PEG-3L alone,PEG-3L+Lin,and PEG-2L+Lin.Primary outcome was Boston Bowel Preparation Scale(BBPS)score and secondary outcomes included adverse event rates,colonoscopy completion rate,withdrawal time,and polyp detection rate.Statistical analysis was performed using independent t-tests and chi-square tests.Results The PEG-3L+Lin group achieved significantly higher BBPS scores than both PEG-3L alone and PEG-2L+Lin groups did(both P<0.001).The PEG-2L+Lin group also outperformed the PEG-3L alone group in cleansing efficacy(90.0%vs.76.7%,P=0.008).The PEG-2L+Lin group demonstrated the best tolerability and lowest adverse event rate,the PEG-3L group had the longest withdrawal time(P<0.05),but the three groups showed no significant difference in polyp detection rates.Conclusion PEG combined with linaclotide significantly improves bowel cleansing in elderly constipated patients.PEG-2L+Lin regimen provides optimal balance between efficacy,safety,and tolerability,making it a preferable choice for this population.

Background: Epimedii Folium, first recorded in the Shennong’s Classic of Materia Medica (Shen Nong Ben Cao Jing), is a traditional Chinese medicine (TCM) known for its effects of “benefiting Qi and strengthening the heart.” Icariside II (ICS II) is one of the main active components of Epimedii Folium, possessing cardiovascular protective and anti-inflammatory properties. However, the potential mechanisms of ICS II on myocardial ischemia (MI) remain unclear. Objective: The aim of the study was to investigate the effects and preliminary molecular mechanisms of ICS II in treating isoproterenolinduced MI in rats. Methods: A rat model of MI was established by subcutaneous injection of isoproterenol. Electrocardiography, echocardiography, myocardial enzymes analysis, heart weight index, triphenyltetrazolium chloride staining, histopathology, TUNEL staining, RT-qPCR, and Western blot were employed to evaluate the effects and preliminary molecular mechanisms of ICS II on MI rats. Results: Pharmacodynamic studies suggested that ICS II inhibited ST-segment elevation in electrocardiograms, improved cardiac function, reduced heart weight index and myocardial enzyme levels, decreased myocardial infarct size, alleviated cardiac histological damage, and inhibited apoptosis, thereby exerting cardioprotective effects in MI rats. Further studies revealed that ICS II may partially inhibit the expression of NLRP3/Caspase-1 axis-related targets at both protein and mRNA levels. Conclusions: Our findings indicate that ICS II exerts anti-MI effects, and its preliminary molecular mechanisms may be related to inhibiting the activation of the NLRP3/Caspase-1 axis to alleviate inflammatory responses.

Background: Epimedii Folium, first recorded in the Shennong’s Classic of Materia Medica (Shen Nong Ben Cao Jing), is a traditional Chinese medicine (TCM) known for its effects of “benefiting Qi and strengthening the heart.” Icariside II (ICS II) is one of the main active components of Epimedii Folium, possessing cardiovascular protective and anti-inflammatory properties. However, the potential mechanisms of ICS II on myocardial ischemia (MI) remain unclear. Objective: The aim of the study was to investigate the effects and preliminary molecular mechanisms of ICS II in treating isoproterenolinduced MI in rats. Methods: A rat model of MI was established by subcutaneous injection of isoproterenol. Electrocardiography, echocardiography, myocardial enzymes analysis, heart weight index, triphenyltetrazolium chloride staining, histopathology, TUNEL staining, RT-qPCR, and Western blot were employed to evaluate the effects and preliminary molecular mechanisms of ICS II on MI rats. Results: Pharmacodynamic studies suggested that ICS II inhibited ST-segment elevation in electrocardiograms, improved cardiac function, reduced heart weight index and myocardial enzyme levels, decreased myocardial infarct size, alleviated cardiac histological damage, and inhibited apoptosis, thereby exerting cardioprotective effects in MI rats. Further studies revealed that ICS II may partially inhibit the expression of NLRP3/Caspase-1 axis-related targets at both protein and mRNA levels. Conclusions: Our findings indicate that ICS II exerts anti-MI effects, and its preliminary molecular mechanisms may be related to inhibiting the activation of the NLRP3/Caspase-1 axis to alleviate inflammatory responses.

Background: Epimedii Folium, first recorded in the Shennong’s Classic of Materia Medica (Shen Nong Ben Cao Jing), is a traditional Chinese medicine (TCM) known for its effects of “benefiting Qi and strengthening the heart.” Icariside II (ICS II) is one of the main active components of Epimedii Folium, possessing cardiovascular protective and anti-inflammatory properties. However, the potential mechanisms of ICS II on myocardial ischemia (MI) remain unclear. Objective: The aim of the study was to investigate the effects and preliminary molecular mechanisms of ICS II in treating isoproterenolinduced MI in rats. Methods: A rat model of MI was established by subcutaneous injection of isoproterenol. Electrocardiography, echocardiography, myocardial enzymes analysis, heart weight index, triphenyltetrazolium chloride staining, histopathology, TUNEL staining, RT-qPCR, and Western blot were employed to evaluate the effects and preliminary molecular mechanisms of ICS II on MI rats. Results: Pharmacodynamic studies suggested that ICS II inhibited ST-segment elevation in electrocardiograms, improved cardiac function, reduced heart weight index and myocardial enzyme levels, decreased myocardial infarct size, alleviated cardiac histological damage, and inhibited apoptosis, thereby exerting cardioprotective effects in MI rats. Further studies revealed that ICS II may partially inhibit the expression of NLRP3/Caspase-1 axis-related targets at both protein and mRNA levels. Conclusions: Our findings indicate that ICS II exerts anti-MI effects, and its preliminary molecular mechanisms may be related to inhibiting the activation of the NLRP3/Caspase-1 axis to alleviate inflammatory responses.

Sustained inflammatory responses are closely related to various severe diseases,and inhibiting the excessive activation of inflammasomes and pyroptosis has significant implications for clinical treatment.Natural products have garnered considerable concern for the treatment of inflammation.Huanglian-Wumei decoction(HLWMD)is a classic prescription used for treating inflammatory diseases,but the necessity of their combination and the exact underlying anti-inflammatory mechanism have not yet been elucidated.Inspired by the supramolecular self-assembly strategy and natural drug compatibility theory,we successfully obtained berberine(BBR)-chlorogenic acid(CGA)supramolecular(BCS),which is an herbal pair from HLWMD.Using a series of characterization methods,we confirmed the self-assembly mechanism of BCS.BBR and CGA were self-assembled and stacked into amphiphilic spherical supra-molecules in a 2:1 molar ratio,driven by electrostatic interactions,hydrophobic interactions,and π-πstacking;the hydrophilic fragments of CGA were outside,and the hydrophobic fragments of BBR were inside.This stacking pattern significantly improved the anti-inflammatory performance of BCS compared with that of single free molecules.Compared with free molecules,BCS significantly attenuated the release of multiple inflammatory mediators and lipopolysaccharide(LPS)-induced pyroptosis.Its anti-inflammatory mechanism is closely related to the inhibition of intracellular nuclear factor-kappaB(NF-κB)p65 phosphorylation and the noncanonical pyroptosis signalling pathway mediated by caspase-11.

Objective To evaluate the correlation between soluble programmed cell death-ligand 1(PD-L1)and clinical features of patients with unstable angina pectoris(UAP),and analyze its correlation with prognosis.Methods A total of 171 UAP patients treated in our hospital from April 2021 to October 2023 were recruited retrospectively,and according to adverse cardiovascular events occurred or not within 6 months of follow-up,they were divided into good prognosis group(137 cases)and poor prognosis group(34 cases).Fasting venous blood sample of 4 ml was collect-ed to detect the levels of soluble PD-L1,LDL-C,HDL-C,hs-CRP,hs-cTnI,IL-6,IL-10 and TNF-α.Pearson correlation analysis was used to analyze the correlation between soluble PD-L1 level and clinical features of the UAP patients,and logistic regression model was employed to evaluate the correlation between soluble PD-L1 and the occurrence of adverse cardiovascular events in the UAP patients.ROC curve analysis was applied to evaluate its performance in predicting the clini-cal prognosis,and its AUC value was calculated.Results The poor prognosis group had signifi-cantly lower LDL-C level and LVEF value,but higher levels of HDL-C,hs-CRP,hs-cTnI,IL-6,IL-10,TNF-α and soluble PD-L1 than the good prognosis group(P＜0.05,P＜0.01).Pearson cor-relation analysis showed that soluble PD-L1 level was positively correlated with hs-CRP level(r=0.502,P=0.000).Multivariate logistic regression analysis indicated that the levels of hs-CRP,hs-cTnI and soluble PD-L1 were independent influencing factors for major cardiovascular adverse events in the UAP patients(OR=2.872,95％CI:1.069-7.717,P=0.036;OR=1.667,95％CI:1.022-2.717,P=0.040;OR=1.152,95％CI:1.023-1.297,P=0.019).ROC curve anal-ysis revealed that soluble PD-L1 had high predictive value for clinical prognosis of UAP patients,with an AUC value of 0.942,a sensitivity of 82.35％and a specificity of 94.16％.Conclusion The increased level of soluble PD-L1 increases the risk of major adverse cardiovascular events in UAP patients.Soluble PD-L1 can be used as a potential new biomarker to predict the clinical prognosis of patients.