Retinal degenerative diseases are a group of blinding ocular disorders characterized by progressive and irreversible loss of retinal neural cells. They mainly include age-related macular degeneration and retinitis pigmentosa. At present, there are no curative clinical therapies capable of reversing the disease course. Patients have poor long-term visual prognosis, imposing a heavy public-health burden on families and society. Mesenchymal stem cell(MSC)-derived exosomes, as a novel cell-free therapeutic vector, have emerged as a research hotspot due to their low immunogenicity, no tumorigenic risk, and excellent tissue barrier penetration ability. This review systematically summarizes the core mechanisms of MSC-derived exosomes in regulating immune inflammation, inhibiting apoptosis, and promoting retinal neuroprotection and structural/functional recovery via miRNA and tsRNA, compares the efficacy differences and existing controversies among exosomes from different sources, and outlines the advances in intraocular delivery technologies and engineering modification strategies. Combined with preclinical and clinical data, the current bottlenecks and safety evidence for clinical translation were objectively described. Meanwhile, in view of the heterogeneity among existing studies, this review proposes future directions including standardized preparation and the establishment of efficacy evaluation systems, so as to provide theoretical references for the development of novel therapeutic strategies for retinal degenerative diseases.

OBJECTIVE:Some studies have shown that physical exercise can effectively improve knee extensor strength and cardiorespiratory function in burn patients;some studies have also shown that physical exercise is not effective in improving respiratory function in burn patients.Improvement effects of physical exercise on physical functions(muscle function,walking function,cardiopulmonary function,and lean body mass)of burn patients were evaluated by a systematic evaluation and meta-analysis.METHODS:Based on databases including Web of Science,PubMed,Embase,Cochrane Library,CNKI,WanFang,and the Chinese Biomedical Database,literature on the improvement of physical function in burn patients through physical exercise was searched using subject headings and free terms.With muscle function,walking ability,cardiopulmonary function,and lean body mass as the primary outcome measures,a meta-analysis was conducted to compare the efficacy of physical exercise with traditional physical therapy or conventional care methods.RESULTS:A total of 38 papers were included,of which 26 papers were included in the meta-analysis,involving 1 658 patients.Meta-analysis results showed that:(1)Physical exercise significantly enhances the knee extensor strength of the dominant leg in burn patients(mean difference[MD]=8.34,95％confidence interval[CI]:6.95-9.72,P＜0.000 01),increases quadriceps strength,peak oxygen uptake,forced vital capacity and maximum ventilation volume in 1 second,and resting heart rate(standardized mean difference[SMD]=4.41,95％CI:2.52-6.30,P＜0.000 01;MD=4.91,95％CI:3.52-6.29,P＜0.000 01;MD=5.86,95％CI:0.09-11.63,P=0.05;MD=6.90,95％CI:2.93-10.87,P=0.000 7;MD=5.03,95％CI:1.45-8.61,P=0.006),and improves the 6-minute walking distance,gait parameters,and total lean body mass(MD=45.29,95％CI:24.7-65.89,P＜0.0001;SMD=7.84,95％CI:6.05-9.63,P＜0.000 01;MD=2.47,95％CI:2.01-2.93,P＜0.000 01).(2)The subgroup analysis results indicated that the improvement in knee extensor strength of the dominant leg may be better in children than in adults and better in the extra-heavy group than in the heavy group.Improvement in the 6-minute walking distance is better in children than in adults,and higher degree of burn indicates better improvement effects,with no difference from the control group for＜12 weeks.Peak oxygen uptake may be better in adults and severe burn groups than in children and moderate burn groups,resistance combined with aerobic exercise modalities may be better than aerobic exercise alone,and exercise duration＞60 minutes may be better than＜60 minutes.CONCLUSION:Physical activity is effective in improving physical function in burn patients,as evidenced by improvements in muscle strength,walking ability,cardiorespiratory fitness,and lean body mass.The quality of evidence recommended for all indicator results is moderate or below,with imprecision and inconsistency being the main factors for downgrading.Therefore,more high-quality randomized controlled trials are needed in the future to verify the reliability of the results.

OBJECTIVE:Some studies have shown that physical exercise can effectively improve knee extensor strength and cardiorespiratory function in burn patients;some studies have also shown that physical exercise is not effective in improving respiratory function in burn patients.Improvement effects of physical exercise on physical functions(muscle function,walking function,cardiopulmonary function,and lean body mass)of burn patients were evaluated by a systematic evaluation and meta-analysis.METHODS:Based on databases including Web of Science,PubMed,Embase,Cochrane Library,CNKI,WanFang,and the Chinese Biomedical Database,literature on the improvement of physical function in burn patients through physical exercise was searched using subject headings and free terms.With muscle function,walking ability,cardiopulmonary function,and lean body mass as the primary outcome measures,a meta-analysis was conducted to compare the efficacy of physical exercise with traditional physical therapy or conventional care methods.RESULTS:A total of 38 papers were included,of which 26 papers were included in the meta-analysis,involving 1 658 patients.Meta-analysis results showed that:(1)Physical exercise significantly enhances the knee extensor strength of the dominant leg in burn patients(mean difference[MD]=8.34,95％confidence interval[CI]:6.95-9.72,P＜0.000 01),increases quadriceps strength,peak oxygen uptake,forced vital capacity and maximum ventilation volume in 1 second,and resting heart rate(standardized mean difference[SMD]=4.41,95％CI:2.52-6.30,P＜0.000 01;MD=4.91,95％CI:3.52-6.29,P＜0.000 01;MD=5.86,95％CI:0.09-11.63,P=0.05;MD=6.90,95％CI:2.93-10.87,P=0.000 7;MD=5.03,95％CI:1.45-8.61,P=0.006),and improves the 6-minute walking distance,gait parameters,and total lean body mass(MD=45.29,95％CI:24.7-65.89,P＜0.0001;SMD=7.84,95％CI:6.05-9.63,P＜0.000 01;MD=2.47,95％CI:2.01-2.93,P＜0.000 01).(2)The subgroup analysis results indicated that the improvement in knee extensor strength of the dominant leg may be better in children than in adults and better in the extra-heavy group than in the heavy group.Improvement in the 6-minute walking distance is better in children than in adults,and higher degree of burn indicates better improvement effects,with no difference from the control group for＜12 weeks.Peak oxygen uptake may be better in adults and severe burn groups than in children and moderate burn groups,resistance combined with aerobic exercise modalities may be better than aerobic exercise alone,and exercise duration＞60 minutes may be better than＜60 minutes.CONCLUSION:Physical activity is effective in improving physical function in burn patients,as evidenced by improvements in muscle strength,walking ability,cardiorespiratory fitness,and lean body mass.The quality of evidence recommended for all indicator results is moderate or below,with imprecision and inconsistency being the main factors for downgrading.Therefore,more high-quality randomized controlled trials are needed in the future to verify the reliability of the results.

This study explores the role and related molecular mechanism of Tianxiangdan (TXD) Capsules in ameliorating atherosclerosis (AS) by regulating GPER (G protein-coupled estrogen receptor) to inhibit NLRP3 inflammasome-mediated pyroptosis. Eight ApoE-/- mice were randomly selected and fed a normal diet as a blank control group, while the remaining ApoE-/- mice were induced with a high-fat diet to establish an atherosclerosis model. These mice were randomly divided into the following groups: model group, atorvastatin intervention group (3.03 mg/kg), TXD Capsules high-dose group (1.092 g/kg), medium-dose TXD group (0.546 g/kg), low-dose TXD group (0.273 g/kg), and medium-dose TXD plus GPER inhibitor (1 mg/kg) group. The effects of TXD Capsules on AS through GPER regulation and inhibition of NLRP3-mediated pyroptosis were evaluated by measuring the serum lipid profile, performing enzyme-linked immunosorbent assays, conducting histopathological analyses, and Western blot. The results showed that TXD significantly reduced serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and inflammatory cytokine levels while increasing high-density lipoprotein cholesterol (HDL-C) levels. TXD also reduced aortic plaque area and lipid deposition. In addition, TXD significantly upregulated GPER expression in aortic tissues and inhibited NLRP3 expression and pyroptosis. These effects were reversed by the GPER inhibitor. In conclusion, TXD may inhibit NLRP3 inflammasome-mediated pyroptosis by upregulating GPER expression, thereby alleviating inflammatory responses in the atherosclerotic microenvironment and exerting vasculoprotective effects.

Objective The purpose of writing the"expert consensus on humanistic care for patients in hospice care"(hereinafter referred to as the"consensus")aims to standardize the practice of humanistic care in the field of hospice care,ensuring that humanistic care is integrated throughout the entire service process for hospice care patients and their families.Methods A systematic search was conducted in domestic and foreign databases for literature related to hospice care and humanistic care,including guidelines,expert consensuses,systematic reviews or Meta-analyses,and evidence summaries.High-quality evidence was evaluated,extracted,and summarized to form the initial draft of the"consensus".From June to October 2024,20 experts from the fields of hospice care,nursing humanities,and evidence-based nursing were invited to participate in 1 round of expert consultation.Among them,13 experts were selected for 2 rounds of expert demonstration meetings.After collating and analyzing the experts' opinions,the initial draft was revised and refined,ultimately resulting in the final version of the"consensus".Results The effective response rate of the consultation questionnaire was 100％,with expert authority coefficient of 0.880,judgment coefficient of 0.935,and familiarity level of 0.825.The Kendall harmony coefficient of the expert consultation was 0.134(P＜0.05).The"consensus"consisted of 13 aspects,including the targets and objectives,principles,institutional guarantees,environmental requirements,etc.Conclusion This"consensus"possesses strong scientific rigor and practicality,which can provide guidance and references for the practice of humanistic care in the field of hospice care,promoting the standardization and humanization of hospice care services.

Objective To investigate the evaluation value of lymphocyte count(LYM),interleukin(IL)-6 and D-dimer on the severity in the patients with sepsis.Methods The clinical data in 107 patients with sepsis admitted and treated in the Emergency ICU(EICU)of this hospital from January 2023 to November 2023 were retrospectively analyzed.The basic clinical data,laboratory routine inflammatory indicators,im-mune indicators,coagulation indicators and the related disease condition score within 24 h after entering EICU were collected.The patients were divided into the sepsis group(n=54)and septic shock group(n=53)ac-cording to whether or not septic shock occurred.The multivariate logistic regression model was used to ana-lyze the influencing factors of septic shock occurrence,the receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency,and Spearman correlation method was used to analyze the correlation between LYM,IL-6 and D-dimer with septic shock occurrence in the patients with sepsis.Results The se-quential organ failure assessment(SOFA)score,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score and the levels of LYM,CRP,IL-6 and D-dimer had statistically significantly differences between the two groups(P＜0.05).The multivariate logistic regression analysis results showed that LYM,IL-6 and D-di-mer were the influencing factors of septic shock occurrence(P＜0.05).The ROC curve analysis results showed that LYM,IL-6 and D-dimer alone or combination detection all had certain predictive value for septic shock occurrence,but the area under the curve(AUC),sensitivity and specificity of the three combined detec-tion were higher than those of detection alone.The Spearman correlation analysis results showed that IL-6(r=0.407)and D-dimer(r=0.482)levels were positively correlated with the severity of septic shock,while the LYM level(r=-0.513)was negatively correlated with the severity of septic shock(P＜0.01).Conclusion The combination application of LYM,IL-6 and D-dimer could effectively evaluate the severity of the patients with sepsis.

Myocardial infarction (MI) is the leading cause of cardiovascular disease-related death worldwide. Nonetheless, existing therapeutic approaches for MI are hampered by issues such as reliance on pharmacological agents and suboptimal patient adherence. Caffeic acid (CA) is a bioactive polyphenolic compound with important anti-inflammatory, anti-bacterial and anti-oxidant functions. Still, its specific role and mechanism in treating cardiovascular disease remain to be further studied. In recent years, a large number of studies have shown that the kelch-like ECH-associated protein 1/nuclear factor erythroid 2 related factor 2 (Keap1/Nrf2) pathway is a key factor in the occurrence and development of cardiovascular diseases. In this study, H₂O₂-induced oxidative stress model of H9c2 cells and left anterior descending branch (LAD) conjunctival induced acute myocardial infarction reperfusion (AMI/R) model were used to evaluate the protective effect of CA on the heart. The interaction between CA and Keap1 was analyzed by CA-labeled fluorescence probe, target fishing, isothermal titration calorimetry (ITC), protein crystallography and surface plasmon resonance (SPR). Our results suggested that CA binds Keap1 and degrades Keap1 in a p62-dependent manner, further promoting nuclear transcription of Nrf2 and thus effectively reducing oxidative stress. In addition, based on the three-dimensional eutectic structure, it was confirmed that CA directly targets Keap1 protein by interacting with residues M550 and N532, inducing conformation changes in Keap1 protein. We also found that the CA analog chlorogenic acid (GCA) can bind Keap1. In conclusion, this study elucidates a novel molecular mechanism and structural basis for the protective effects of CA against oxidative damage via the Keap1-Nrf2 pathway.

Objective Based on statistical parametric mapping(SPM),to analyze the variability characteristics of lower limb in females with generalized joint hypermobility(GJH)during drop jump.Methods Fifteen females with GJH(GJH group)were recruited based on the Beighton scores,and 15 healthy females(control group)were matched.Kinematic and kinetic data were synchronously collected using the Qualisys infrared motion capture system and Kistler three-dimensional(3D)force platform.Joint angles and torques were computed using OpenSim.Custom Matlab scripts were used to calculate the standard deviation curves of joint angles,and SPM was applied to analyze differences in movement variability between the two groups during the eccentric,coupling,and concentric phases of drop jumps.The maximum joint flexion angles and torques(mean and standard deviation)were calculated to support the findings,and effect sizes were evaluated using Cohen's d.Results Significant differences were observed between the two groups during various phases of drop jumps.In all statistically significant periods,the GJH group exhibited higher joint angle standard deviations compared to the control group(P＜0.05).Differences were primarily concentrated in joint flexion movements.During the coupling phase at different heights,the standard deviation of knee joint flexion angles in GJH group consistently exceeded that of control group(P＜0.001).Discrete variables showed significant differences in the standard deviation of the maximum knee flexion angles at different heights:At 30 cm,P=0.001,Cohen's d=2.520;at 40 cm,P=0.014,Cohen's d=1.739;and at 50 cm,P=0.005,Cohen's d=1.768.No significant group differences were found in the mean values or standard deviations of the maximum joint flexion angles and torques.Conclusions Females with GJH exhibit higher movement variability during drop jumps compared to healthy females,particularly in knee flexion movements during the coupling phase.Excessive variability reflects insufficient motor control,reducing their ability to resist external disturbances and leading to high-risk movement patterns(e.g.,excessive flexion or knee valgus).