Objective To investigate the value of prone-position MRI of lumbar spine for diagnosing pediatric occult tethered cord syndrome(OTCS).Methods A total of 67 children with suspected tethered cord syndrome(TCS)and confirmed OTCS by surgery were prospectively enrolled as OTCS group,while 73 healthy subjects were recruited as control group.Supine-and prone-position lumbar MR examinations were performed in both groups.The position of filum terminale on prone axial T2WI and the presence or absence of"sunset sign"(i.e.filum terminale located within the dorsal 1/2 of spinal canal on prone axial T2WI)were observed,spinal cord conus mobility was calculated.The efficacy of"sunset sign"for diagnosing OTCS in children was calculated through comparison between groups.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to evaluate the diagnostic efficacy of spinal cord conus mobility.Results On prone-position axial T2WI,"sunset sign"was found in 58 cases(58/67,86.57％)but not in 9 cases(9/67,13.43％)in OTCS group,which was not even observed in control group.The sensitivity of"sunset sign"for diagnosing pediatric OTCS was 86.57％(58/67),with specificity of 100％(73/73),positive predictive value of 100％(58/58)and negative predictive value of 89.02％(73/82).The spinal cord conus mobility was(19.30±5.89)％in OTCS group and(31.71±6.58)％in control group,being statistically different between groups(t=-11.722,P＜0.001).The sensitivity,specificity and AUC of spinal cord conus mobility for diagnosing pediatric OTCS was 80.60％,90.41％and 0.920,respectively.Conclusion Prone-position MRI of lumbar spine could be used in diagnosing pediatric OTCS.

Objective To observe the volume changes of brain regions and their correlation with cognitive function in temporal lobe epilepsy(TLE)patients.Methods Fifty TLE patients(TLE group)and 34 healthy controls(control group)were prospectively enrolled.Brain 3D-T1WI was collected,brain regions were delineated with automated segmentation technique,and hippocampus was segmented additionally with hippocampal brain template(HBT).The volume of brain regions were compared between groups,and the correlation of brain region volume with Montreal cognitive assessment(MoCA)score were analyzed.Results Compared with control group,in TLE group,bilateral cerebrum white matter,right globus pallidus,left posterior cingulate gyrus,left precentral gyrus,right fusiform gyrus,left cerebellum white matter,corpus callosum,left hippocampus(HBT segmentation and conventional segmentation)and right thalamus volumes decreased significantly(all P＜0.05),while right choroid plexus volume increased significantly(P＜0.05).The volume of left hippocampus(HBT segmentation)and right fusiform gyrus were both positively correlated with MoCA score in TLE group(r=0.335,0.376,P=0.009,0.007).Conclusion Widespread atrophy of brain regions could be seen in TLE patients,which were correlated with cognitive function.

Objective To investigate the value of prone-position MRI of lumbar spine for diagnosing pediatric occult tethered cord syndrome(OTCS).Methods A total of 67 children with suspected tethered cord syndrome(TCS)and confirmed OTCS by surgery were prospectively enrolled as OTCS group,while 73 healthy subjects were recruited as control group.Supine-and prone-position lumbar MR examinations were performed in both groups.The position of filum terminale on prone axial T2WI and the presence or absence of"sunset sign"(i.e.filum terminale located within the dorsal 1/2 of spinal canal on prone axial T2WI)were observed,spinal cord conus mobility was calculated.The efficacy of"sunset sign"for diagnosing OTCS in children was calculated through comparison between groups.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to evaluate the diagnostic efficacy of spinal cord conus mobility.Results On prone-position axial T2WI,"sunset sign"was found in 58 cases(58/67,86.57％)but not in 9 cases(9/67,13.43％)in OTCS group,which was not even observed in control group.The sensitivity of"sunset sign"for diagnosing pediatric OTCS was 86.57％(58/67),with specificity of 100％(73/73),positive predictive value of 100％(58/58)and negative predictive value of 89.02％(73/82).The spinal cord conus mobility was(19.30±5.89)％in OTCS group and(31.71±6.58)％in control group,being statistically different between groups(t=-11.722,P＜0.001).The sensitivity,specificity and AUC of spinal cord conus mobility for diagnosing pediatric OTCS was 80.60％,90.41％and 0.920,respectively.Conclusion Prone-position MRI of lumbar spine could be used in diagnosing pediatric OTCS.

Objective:To investigate the clinically curative effect of composite dressing of adipose mesenchymal stem cell exosomes and chitosan hydrogel in treating deep Ⅱ burn wound.Methods:A total of 108 patients with superficially deep Ⅱ burns,who admitted to Tangdu Hospital,Air Force Medical University within 48 hours during March 2022 and October 2024,were selected.Patients were randomly divided into conventional treatment group and the combined treatment group by using a random number table,with 54 patients in each group.All patients underwent enzymatic debridement(collagenase ointment)to conduct conventional treatment.The combined treatment group received treatment with composite dressings of adipose-derived mesenchymal stem cell exosomes(ADSCs-Exo)combined with chitosan hydrogel,while the conventional treatment group received treatment with silver sulfadiazine dressings(SSD)on the basis of conventional treatment.The healing rates of wound,Vancouver Scar Scale(VSS)scores,the levels of serum inflammatory factors included interleukin-6(IL-6),interleukin-1β(IL-1β),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α),as well as curative efficacy rates,and adverse reactions between two groups were compared at different time points after treatment.Results:There was not statistically significant difference in healing rates of wound between the two groups at the 7th day after treatment(P>0.05).At the 14th day and the 21th day after treatment,the average healing rates of wound in the combined treatment group were respectively(67.69±8.57)%and(89.46±7.54)%,which were higher than(59.50±4.93)%and(75.52±9.11)%in the conventional treatment group,and the differences were statistically significant(t=6.087,8.662,P<0.05).The average VSS score was(6.42±1.20)points in the combined treatment group after treatment,which was lower than that in the conventional treatment group(8.94±1.58),and the difference was statistically significant(t=9.33,P<0.05).Before treatment,there were not statistically significant difference in VAS scores and the levels of serum inflammatory factor between the two groups(P>0.05).At the 7th day,the 14th day and the 21th day after treatment,the VAS scores in the combined treatment group were significantly lower than those in the conventional treatment group(t=10.008,12.004,13.899,P<0.05),respectively.At the 21th day after treatment,the levels of IL-6,IL-1β,CRP,and TNF-α of the combined treatment group were significantly lower than those of the conventional treatment group(t=3.400,4.490,7.293,5.900,P<0.05).The efficacy rate of clinical treatment in the combined treatment group was 96.30%,which was higher than 83.33%of the conventional treatment group,with a statistical significance(x2=7.942,P<0.05).The incidence of adverse reaction in the combined treatment group was 14.81%,which was lower than 24.07%of the conventional treatment group,without statistical significance(P>0.05).Conclusion:Compared with conventional silver sulfadiazine dressing,the composite dressing of adipose mesenchymal stem cell exosomes and chitosan hydrogel can quickly promote the re-epithelialization process in treating patients with superficially deep Ⅱ burns at the middle to late stage,and improve the healing rate,and relieve the inflammatory reaction and pain perception of patients for wound,and enhance efficiency and safety.

Objective To observe the volume changes of brain regions and their correlation with cognitive function in temporal lobe epilepsy(TLE)patients.Methods Fifty TLE patients(TLE group)and 34 healthy controls(control group)were prospectively enrolled.Brain 3D-T1WI was collected,brain regions were delineated with automated segmentation technique,and hippocampus was segmented additionally with hippocampal brain template(HBT).The volume of brain regions were compared between groups,and the correlation of brain region volume with Montreal cognitive assessment(MoCA)score were analyzed.Results Compared with control group,in TLE group,bilateral cerebrum white matter,right globus pallidus,left posterior cingulate gyrus,left precentral gyrus,right fusiform gyrus,left cerebellum white matter,corpus callosum,left hippocampus(HBT segmentation and conventional segmentation)and right thalamus volumes decreased significantly(all P＜0.05),while right choroid plexus volume increased significantly(P＜0.05).The volume of left hippocampus(HBT segmentation)and right fusiform gyrus were both positively correlated with MoCA score in TLE group(r=0.335,0.376,P=0.009,0.007).Conclusion Widespread atrophy of brain regions could be seen in TLE patients,which were correlated with cognitive function.

Objective:To investigate the clinically curative effect of composite dressing of adipose mesenchymal stem cell exosomes and chitosan hydrogel in treating deep Ⅱ burn wound.Methods:A total of 108 patients with superficially deep Ⅱ burns,who admitted to Tangdu Hospital,Air Force Medical University within 48 hours during March 2022 and October 2024,were selected.Patients were randomly divided into conventional treatment group and the combined treatment group by using a random number table,with 54 patients in each group.All patients underwent enzymatic debridement(collagenase ointment)to conduct conventional treatment.The combined treatment group received treatment with composite dressings of adipose-derived mesenchymal stem cell exosomes(ADSCs-Exo)combined with chitosan hydrogel,while the conventional treatment group received treatment with silver sulfadiazine dressings(SSD)on the basis of conventional treatment.The healing rates of wound,Vancouver Scar Scale(VSS)scores,the levels of serum inflammatory factors included interleukin-6(IL-6),interleukin-1β(IL-1β),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α),as well as curative efficacy rates,and adverse reactions between two groups were compared at different time points after treatment.Results:There was not statistically significant difference in healing rates of wound between the two groups at the 7th day after treatment(P>0.05).At the 14th day and the 21th day after treatment,the average healing rates of wound in the combined treatment group were respectively(67.69±8.57)%and(89.46±7.54)%,which were higher than(59.50±4.93)%and(75.52±9.11)%in the conventional treatment group,and the differences were statistically significant(t=6.087,8.662,P<0.05).The average VSS score was(6.42±1.20)points in the combined treatment group after treatment,which was lower than that in the conventional treatment group(8.94±1.58),and the difference was statistically significant(t=9.33,P<0.05).Before treatment,there were not statistically significant difference in VAS scores and the levels of serum inflammatory factor between the two groups(P>0.05).At the 7th day,the 14th day and the 21th day after treatment,the VAS scores in the combined treatment group were significantly lower than those in the conventional treatment group(t=10.008,12.004,13.899,P<0.05),respectively.At the 21th day after treatment,the levels of IL-6,IL-1β,CRP,and TNF-α of the combined treatment group were significantly lower than those of the conventional treatment group(t=3.400,4.490,7.293,5.900,P<0.05).The efficacy rate of clinical treatment in the combined treatment group was 96.30%,which was higher than 83.33%of the conventional treatment group,with a statistical significance(x2=7.942,P<0.05).The incidence of adverse reaction in the combined treatment group was 14.81%,which was lower than 24.07%of the conventional treatment group,without statistical significance(P>0.05).Conclusion:Compared with conventional silver sulfadiazine dressing,the composite dressing of adipose mesenchymal stem cell exosomes and chitosan hydrogel can quickly promote the re-epithelialization process in treating patients with superficially deep Ⅱ burns at the middle to late stage,and improve the healing rate,and relieve the inflammatory reaction and pain perception of patients for wound,and enhance efficiency and safety.

Background::Cerebrovascular disease (CVD) ranks among the foremost factors responsible for mortality on a global scale. The mortality patterns of CVDs and temporal trends in China need to be well-illustrated and updated.Methods::We collected mortality data on patients with CVD from Chinese Center for Disease Control and Prevention’s Disease Surveillance Points (CDC-DSP) system. The mortality of CVD in 2020 was described by age, sex, residence, and region. The temporal trend from 2013 to 2019 was evaluated using joinpoint regression, and estimated rates of decline were extrapolated until 2030 using time series models.Results::In 2019, the age-standardized mortality in China (ASMRC) per 100,000 individuals was 113.2. The ASMRC for males (137.7/10 5) and rural areas (123.0/10 5) were both higher when stratified by gender and urban/rural residence. The central region had the highest mortality (126.5/10 5), the western region had a slightly lower mortality (123.5/10 5), and the eastern region had the lowest mortality (97.3/10 5). The age-specific mortality showed an accelerated upward trend from aged 55-59 years, with maximum mortality observed in individuals over 85 years of age. The age-standardized mortality of CVD decreased by 2.43% (95% confidence interval, 1.02-3.81%) annually from 2013 to 2019. Notably, the age-specific mortality of CVD increased from 2013 to 2019 for the age group of over 85 years. In 2020, both the absolute number of CVD cases and the crude mortality of CVD have increased compared to their values in 2019. The estimated total deaths due to CVD were estimated to reach 2.3 million in 2025 and 2.4 million in 2030. Conclusion::The heightened focus on the burden of CVD among males, rural areas, the central and western of China, and individuals aged 75 years and above has emerged as a pivotal determinant in further decreasing mortalities, consequently presenting novel challenges to strategies for disease prevention and control.

Objective:To study the effects and mechanisms of activation of human lung fibroblasts (MRC-5) by exosomal RNA hsa _ circ _ 0006357 (circEZH2) derived from non-small cell lung cancer.Methods:Western blot was used to detect exosome molecular markers, reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR) and cell invasion assays to detect the effect of non-small cell lung cancer-derived exosomes on MRC-5 activation. A circRNA microarray analysis was performed in serum exosomes from patients with non-small cell lung cancer (collected at Ningbo University People's Hospital, September 2023), and levels of circEZH2 were measured in serum exosomes from non-small cell lung cancer by RT-qPCR analysis. The effects of circEZH2 on MRC-5 activation were explored using wound healing assays, Transwell assays, RT-qPCR, cellular immunofluorescence, and western blot. The regulatory effect of circEZH2 on miR-495-3p/TPD52 axis and NF-κB pathway through dual-luciferase assay, immunofluorescence, and western blot.Results:Exosomes derived from non-small cell lung cancer cells were shown to promote MRC-5 cell invasiveness, the number of cells invaded in co-culture with exosomes derived from normal human bronchial epithelial cells was (42±5), and the number of cells invaded in co-culture with exosomes derived from non-small cell lung cancer cells (SPC-A1, H1299, A549 cells) was (246±7), (89±4), (69±14), expression of markers of fibroblast activation (α-SMA, FAP), and cytokines (IL-6, IL-8, P＜0.05). CircEZH2 expression was significantly upregulated in the serum exosomes of non-small cell lung cancer ( P＜0.01). Alternatively, co-culture of exosomes derived from non-small cell lung cancer cells with MRC-5 cells promoted circEZH2 expression ( P＜0.05). Functionally, overexpression of circEZH2 promoted MRC-5 cell migration and invasion [the cell migration rates were (30.81±2.54)% and (60.29±8.34)%, respectively, and the cell invasion numbers were (48.00±13.58) and (115.00±9.50), respectively, P＜0.05]. RT-qPCR, western blot, and immunofluorescence assays demonstrated a significant increase in the expression of the pro-inflammatory genes IL-6 and IL-8 in MRC-5 cells as well as the activation markers α-SMA and FAP in fibroblasts ( P＜0.05) following the expression of circEZH2. Mechanistically, circEZH2 may function as ceRNA to regulate miR-495-3p, promote the expression of TPD52, and activate the NF-κB pathway to promote the activation of MRC-5. Conclusion:Exosomal circEZH2, derived from non-small cell lung cancer, may promote the activation of fibroblasts by activating the NF-κB pathway through the miR-495-3p/TPD52 axis.

Objective To investigate the clinical manifestations,molecular genetics and gonadal pathol-ogy characteristics of patients with disorders of sex development(DSD),and to summarize the clinical experi-ence of identifying rare diseases from common symptoms.Methods The clinical data of 416 patients with DSD diagnosed and treated in the multidisciplinary center of DSD of Guangzhou Women and Children's Medical Cen-ter from May 2018 to August 2023 were retrospectively analyzed,summarized and discussed.Results Accord-ing to chromosome karyotype,416 cases of DSD were classified into three types:92 cases(22.1％)of abnormal sex chromosome karyotype,285 cases(68.5％)of 46,XY karyotype and 39 cases(9.4％)of 46,XX karyotype.Among the 92 patients with abnormal sex chromosome karyotype,59 cases were raised as males,18 cases(30.5％)complained of short penis with hypospadias and cryptorchidism.The most common karyotype was 45,X/46,XY(58 cases,63.0％).Among the 285 patients with 46,XY karyotype,238 cases were raised as males,and 63 cases(26.5％)complained of short penis and hypospadias;47 cases were raised as females,and 13 ca-ses(27.7％)complained of inguinal mass.A total of 216 patients with 46,XY karyotype were subjected to whole exome gene detection,and 155 cases(71.8％)were found to have molecular pathogenesis with the clinical phe-notype.Among the 39 patients with 46,XX karyotype,19 cases were raised as males,and 8 cases(42.1％)com-plained of short penis and hypospadias.In the 18 cases of gonad biopsy,17 cases showed testicular tissue in go-nads.Whole exome sequencing was performed in 14 cases.NR5A1 gene heterozygous mutation,SRY gene muta-tion and SOX3 gene mutation were found in 2 cases,respectively(14.3％).Twenty cases were raised as females,and 14 cases(70.0％)complained of clitoral hypertrophy.Gonad biopsy was performed in 8 cases,with 7 cases of ovotestis(87.5％)and 1 case of NR5A1 gene heterozygous mutation(14.3％).Conclusions The etiologies of DSD are complex and diverse,and the clinical manifestations are various,which can be manifested as hypospa-dias,micropenis,cryptorchidism and other common symptoms of the urinary system.Different etiologies have dif-ferent treatment options.Therefore,chromosome karyotype,molecular genetic testing and gonadal pathology can be used to clarify the cause of disease,especially for rare diseases,improve the detection rate,reduce the rate of missed diagnosis,and ensure reasonable treatment,especially sex selection.

Objective:To study the effects and mechanisms of activation of human lung fibroblasts (MRC-5) by exosomal RNA hsa _ circ _ 0006357 (circEZH2) derived from non-small cell lung cancer.Methods:Western blot was used to detect exosome molecular markers, reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR) and cell invasion assays to detect the effect of non-small cell lung cancer-derived exosomes on MRC-5 activation. A circRNA microarray analysis was performed in serum exosomes from patients with non-small cell lung cancer (collected at Ningbo University People's Hospital, September 2023), and levels of circEZH2 were measured in serum exosomes from non-small cell lung cancer by RT-qPCR analysis. The effects of circEZH2 on MRC-5 activation were explored using wound healing assays, Transwell assays, RT-qPCR, cellular immunofluorescence, and western blot. The regulatory effect of circEZH2 on miR-495-3p/TPD52 axis and NF-κB pathway through dual-luciferase assay, immunofluorescence, and western blot.Results:Exosomes derived from non-small cell lung cancer cells were shown to promote MRC-5 cell invasiveness, the number of cells invaded in co-culture with exosomes derived from normal human bronchial epithelial cells was (42±5), and the number of cells invaded in co-culture with exosomes derived from non-small cell lung cancer cells (SPC-A1, H1299, A549 cells) was (246±7), (89±4), (69±14), expression of markers of fibroblast activation (α-SMA, FAP), and cytokines (IL-6, IL-8, P＜0.05). CircEZH2 expression was significantly upregulated in the serum exosomes of non-small cell lung cancer ( P＜0.01). Alternatively, co-culture of exosomes derived from non-small cell lung cancer cells with MRC-5 cells promoted circEZH2 expression ( P＜0.05). Functionally, overexpression of circEZH2 promoted MRC-5 cell migration and invasion [the cell migration rates were (30.81±2.54)% and (60.29±8.34)%, respectively, and the cell invasion numbers were (48.00±13.58) and (115.00±9.50), respectively, P＜0.05]. RT-qPCR, western blot, and immunofluorescence assays demonstrated a significant increase in the expression of the pro-inflammatory genes IL-6 and IL-8 in MRC-5 cells as well as the activation markers α-SMA and FAP in fibroblasts ( P＜0.05) following the expression of circEZH2. Mechanistically, circEZH2 may function as ceRNA to regulate miR-495-3p, promote the expression of TPD52, and activate the NF-κB pathway to promote the activation of MRC-5. Conclusion:Exosomal circEZH2, derived from non-small cell lung cancer, may promote the activation of fibroblasts by activating the NF-κB pathway through the miR-495-3p/TPD52 axis.