BACKGROUND:The self-renewal and multi-directional differentiation of pluripotent stem cells possess the potential to revolutionize people's understanding of biology,medicine,development,and disease.Stem cells play an important role in the early stage of embryonic development,and the study of them could be beneficial to understanding of the basic principles of biological development and tissue or organ formation,exploring the potential mechanisms of various diseases,studying the repair and regeneration of damaged tissues or organs,and promoting drug discovery and personalized treatment. OBJECTIVE:To review the research progress of pluripotent stem cells,summarize and categorize the fundamental types of pluripotent stem cells,and elucidate the lineage situations of various types of pluripotent stem cells in common mammals. METHODS:PubMed,Web of Science,CNKI,and WanFang databases were searched systematically,with the keywords"pluripotent stem cells;embryonic stem cells;induced pluripotent stem cells;expanded potential stem cells;livestock pluripotent stem cells"in English and Chinese.The 99 articles related to mammalian pluripotent stem cells were systematically screened according to inclusion and exclusion criteria,and then reviewed. RESULTS AND CONCLUSION:(1)According to classical theory in mouse embryonic stem cell research,the pluripotent state of stem cells is divided into two forms:na?ve and primed.Na?ve state corresponds to the inner cell mass of pre-implantation embryos before attachment to the uterine wall,while primed state corresponds to the epiblast after implantation.These two states exhibit significant differences in epigenetic features,transcriptional activity,external signal dependency,and metabolic phenotype.It is later discovered that there is an intermediate state between na?ve and primed called formative pluripotency.Therefore,the pluripotency of pluripotent stem cells is a continuous developmental process rather than a unique cell state.(2)In addition to obtaining pluripotent stem cells from the inner cell mass,there are various methods and lineages for acquiring pluripotent stem cells,including embryonic germ cells established using primitive germ cells from mouse embryos,induced pluripotent stem cells created by the dedifferentiation of adult mouse and human fibroblasts with four factors—Oct3/4,Sox2,c-Myc,and Klf4;embryonic stem cell-like cell lines cultured from somatic cell nuclear transfer,parthenogenesis,neonatal or adult testicular or ovarian tissue,very small embryonic-like stem cells derived from various adult tissues and expanded pluripotent stem cells derived from pre-implantation stages.These pluripotent stem cells all share the common characteristics of continuous self-renewal,expressing core pluripotency factors and possessing the ability to differentiate into the three primary germ layers.(3)Currently,pluripotent stem cells are being used for disease modeling to study the mechanisms of various diseases and develop new drugs.Simultaneously,scientists are attempting to use pluripotent stem cells to cultivate various tissues and organs,offering new possibilities for regenerative medicine and transplantation.However,the clinical application of pluripotent stem cells faces safety challenges,including issues of cell mutations and immune rejection.Continual improvement in the methods of generating pluripotent stem cells will make them safer and more efficient for clinical applications.(4)Based on the methods of obtaining and lineage establishment of pluripotent stem cells in mice and humans,various types of pluripotent stem cells have been established in livestock,including embryonic stem cells,induced pluripotent stem cells,germ lineages of pluripotent stem cells,and expanded potential stem cells.Research on livestock pluripotent stem cells opens up new avenues for animal reproduction,breeding,genetic engineering,disease modeling,drug screening,and the conservation of endangered wildlife.

Objective:To investigate the effect of CT-derived fractional flow reserve (CT-FFR) measurement sites on the values and the diagnostic performance, and to determine the optimal measurement site for CT-FFR using invasive FFR as the reference standard.Methods:This study was part of the CT-FFR CHINA clinical trial. Patients with suspected coronary artery disease who were scheduled for invasive coronary angiography (ICA) were prospectively recruited from five clinical centers across the country from November 2018 to March 2020. Each enrolled patient underwent coronary CT angiography (CCTA), CT-FFR, ICA, and invasive pressure wire-based FFR assessments sequentially within one week. Four groups of CT-FFR values were obtained on each enrolled target vessels according to different CT-FFR measurement locations: 1, 2, 3 cm distal to the target lesion, and terminal vessel groups. Spearman and Bland-Altman analyses were used to explore the correlation and consistency of CT-FFR values and FFR values at different measurement sites. The measurement deviation of CT-FFR was also compared. Diagnostic accuracy and performance of CT-FFR, including sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC), in discriminating myocardial ischemia were analyzed across all measurement site groups on a per-vessel level, using FFR as the reference standard.Results:A total of 289 patients with 345 target lesion vessels were included. According to CCTA, there were 51 target vessels (14.8%) with<50% stenosis, 106 vessels (30.7%) with 50%-69% stenosis, and 188 vessels (54.5%) with stenosis≥70%. At per-vessel level, CT-FFR and FFR values at each measurement position group were highly positively correlated: 1 cm distal to target lesion group, r=0.734 ( P<0.001); 2 cm distal to target lesion group, r=0.732 ( P<0.001); 3 cm distal to target lesion group, r=0.737 ( P<0.001); terminal vessel group was 0.719 ( P<0.001). At per-vessel level, CT-FFR and FFR values of all measurement sites were in good agreement (Bland-Altman analysis results): 1 cm distal to target lesion group, 0.014 (95% LoA 0.002-0.026); 2 cm distal to target lesion group, 0.026 (95% LoA 0.015-0.038); 3 cm distal to target lesion group, 0.040 (95% LoA 0.039-0.051); terminal vessel group, 0.075 (95% LoA 0.064-0.087). And at per-vessel level, the accuracy of diagnosing myocardial ischemia with CT-FFR at 1 cm was highest [84.6% (95% CI 80.4%-88.3%)], and the lowest accuracy in the terminal vessel group [67.0% (95% CI 61.7%-72.0%)]. However, there was no significant difference in the diagnostic accuracy of CT-FFR at 1 cm, 2 cm [80.6% (95% CI 76.1%-84.6%)] and 3 cm [77.5% (95% CI 72.6%-81.7%)]. AUC of CT-FFR at 1 cm distal to the lesion were both highest for global level and moderately stenosis (50%-69%) lesions [0.85 (95% CI 0.81-0.89), 0.84 (95% CI 0.77-0.90)]. And the differences were statistically significant among the four measurement location groups (all P<0.05). Conclusions:The deviation of CT-FFR increases with measurement site distance distal to target lesions. One centimeter distal to the target lesion is the optimal measurement site, and the CT-FFR value here shows the highest diagnostic performance for myocardial ischemic lesions, especially for moderate stenosis.

Objective To analyze the changing trends and epidemiological characteristics of the disease burden of blindness caused by type 2 diabetes mellitus(T2DM)in China from 1990 to 2021,and to predict the trends up to 2035.Methods Based on the standardized methodology of the Global Burden of Disease Study 2021,the age-standardized rates(ASRs)and their corresponding 95％uncertainty intervals(UI)for prevalence and years lived with disability(YLDs)rate were used to systematically describe the disease burden of blindness caused by T2DM in China.The temporal trends[esti-mated annual percentage change(EAPC)]and epidemiological characteristics were assessed,with attention to age and sex differences,to predict the trends in the disease burden up to 2035.Results From 1990 to 2021,the age-standardized prevalence rate increased from 6.03 per 100 000(95％UI:4.46-8.18)to 10.35 per 100 000(7.60-13.69),and the age-standardized YLDs rate increased from 1.09 per 100 000(95％UI:0.67-1.70)to 1.88 per 100 000(95％UI:1.21-2.90),with an EAPC of 2.18(95％CI:1.73-2.64).The disease burden was relatively heavier in females and the elderly population.Epidemiological changes,population growth,and aging collectively drove the increase in the burden of blind-ness caused by T2DM.The disease burden of blindness caused by T2DM is projected to continue rising by 2035.Conclu-sion The disease burden of blindness caused by T2DM in China continues to increase,with a relatively heavier burden on females and the elderly population.Future research should optimize the equity of medical resource allocation and conduct studies on the mechanisms of sex differences to enable precise interventions with evidence-based strategies.

Objective:To evaluate the effect of open reduction and internal fixation versus humeral head replacement on postoperative recovery of shoulder joint function in a population of patients with comminuted fractures of the proximal humerus. Methods:This study was a case-control study that retrospectively analyzed data from 80 patients with comminuted fractures of the proximal humerus who underwent surgical treatment at the Department of Orthopedics at Xi'an Gaoxin Hospital from January 2020 to December 2023. The patients were divided into two groups based on the surgical method: the control group ( n = 45) received open reduction and internal fixation, while the observation group ( n = 35) underwent humeral head replacement. Surgery-related indexes, as well as therapeutic effect ratings, shoulder joint mobility, and shoulder joint function 3 months post-surgery, were compared between the two groups. Additionally, the incidence of complications occurring during the treatment was also compared between the two groups. Results:In the observation group, the intraoperative blood loss, surgery duration, postoperative drainage amount, and length of hospital stay were (186.92 ± 28.04) mL, (68.89 ± 10.12) minutes, (57.89 ± 11.25) mL, and (10.18 ± 2.41) days, respectively, all of which were significantly lower than those in the control group, which were (218.23 ± 35.57) mL, (98.26 ± 15.34) minutes, (73.65 ± 13.68) mL, and (12.35 ± 2.92) days ( t = 4.27, 9.78, 5.51, 3.55, all P < 0.05). There was no statistically significant difference in the therapeutic effect between the two groups 3 months post-surgery [97.14% (34/35) vs. 95.56% (43/45), χ2 = 0.04, P > 0.05]. At 3 months post-surgery, the angles of forward elevation, external rotation, and internal rotation in the observation group were (95.42 ± 7.88)°, (61.37 ± 6.56)°, and (74.38 ± 5.01)°, respectively, while in the control group they were (93.68 ± 7.75)°, (60.42 ± 6.87)°, and (73.75 ± 4.92)°, respectively. The differences were not statistically significant between the two groups ( t = -0.98, -0.62, -0.56, all P > 0.05). At 3 months post-surgery, the shoulder function score in the observation group was (73.46 ± 9.15), which was not significantly different from that in the control group [(71.75 ± 8.66), t = -0.85, P > 0.05]. The incidence of complications in the observation group was 2.86% (1/35), which was significantly lower than that in the control group [22.22% (10/45), χ2 = 4.70, P = 0.030). Conclusions:For patients with comminuted fractures of the proximal humerus, both open reduction and internal fixation and humeral head replacement can achieve good shoulder joint function recovery. However, humeral head replacement is more advantageous than open reduction and internal fixation during the perioperative period.

Objective To analyze the changing trends and epidemiological characteristics of the disease burden of blindness caused by type 2 diabetes mellitus(T2DM)in China from 1990 to 2021,and to predict the trends up to 2035.Methods Based on the standardized methodology of the Global Burden of Disease Study 2021,the age-standardized rates(ASRs)and their corresponding 95％uncertainty intervals(UI)for prevalence and years lived with disability(YLDs)rate were used to systematically describe the disease burden of blindness caused by T2DM in China.The temporal trends[esti-mated annual percentage change(EAPC)]and epidemiological characteristics were assessed,with attention to age and sex differences,to predict the trends in the disease burden up to 2035.Results From 1990 to 2021,the age-standardized prevalence rate increased from 6.03 per 100 000(95％UI:4.46-8.18)to 10.35 per 100 000(7.60-13.69),and the age-standardized YLDs rate increased from 1.09 per 100 000(95％UI:0.67-1.70)to 1.88 per 100 000(95％UI:1.21-2.90),with an EAPC of 2.18(95％CI:1.73-2.64).The disease burden was relatively heavier in females and the elderly population.Epidemiological changes,population growth,and aging collectively drove the increase in the burden of blind-ness caused by T2DM.The disease burden of blindness caused by T2DM is projected to continue rising by 2035.Conclu-sion The disease burden of blindness caused by T2DM in China continues to increase,with a relatively heavier burden on females and the elderly population.Future research should optimize the equity of medical resource allocation and conduct studies on the mechanisms of sex differences to enable precise interventions with evidence-based strategies.

Objective:To investigate the effect of CT-derived fractional flow reserve (CT-FFR) measurement sites on the values and the diagnostic performance, and to determine the optimal measurement site for CT-FFR using invasive FFR as the reference standard.Methods:This study was part of the CT-FFR CHINA clinical trial. Patients with suspected coronary artery disease who were scheduled for invasive coronary angiography (ICA) were prospectively recruited from five clinical centers across the country from November 2018 to March 2020. Each enrolled patient underwent coronary CT angiography (CCTA), CT-FFR, ICA, and invasive pressure wire-based FFR assessments sequentially within one week. Four groups of CT-FFR values were obtained on each enrolled target vessels according to different CT-FFR measurement locations: 1, 2, 3 cm distal to the target lesion, and terminal vessel groups. Spearman and Bland-Altman analyses were used to explore the correlation and consistency of CT-FFR values and FFR values at different measurement sites. The measurement deviation of CT-FFR was also compared. Diagnostic accuracy and performance of CT-FFR, including sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC), in discriminating myocardial ischemia were analyzed across all measurement site groups on a per-vessel level, using FFR as the reference standard.Results:A total of 289 patients with 345 target lesion vessels were included. According to CCTA, there were 51 target vessels (14.8%) with<50% stenosis, 106 vessels (30.7%) with 50%-69% stenosis, and 188 vessels (54.5%) with stenosis≥70%. At per-vessel level, CT-FFR and FFR values at each measurement position group were highly positively correlated: 1 cm distal to target lesion group, r=0.734 ( P<0.001); 2 cm distal to target lesion group, r=0.732 ( P<0.001); 3 cm distal to target lesion group, r=0.737 ( P<0.001); terminal vessel group was 0.719 ( P<0.001). At per-vessel level, CT-FFR and FFR values of all measurement sites were in good agreement (Bland-Altman analysis results): 1 cm distal to target lesion group, 0.014 (95% LoA 0.002-0.026); 2 cm distal to target lesion group, 0.026 (95% LoA 0.015-0.038); 3 cm distal to target lesion group, 0.040 (95% LoA 0.039-0.051); terminal vessel group, 0.075 (95% LoA 0.064-0.087). And at per-vessel level, the accuracy of diagnosing myocardial ischemia with CT-FFR at 1 cm was highest [84.6% (95% CI 80.4%-88.3%)], and the lowest accuracy in the terminal vessel group [67.0% (95% CI 61.7%-72.0%)]. However, there was no significant difference in the diagnostic accuracy of CT-FFR at 1 cm, 2 cm [80.6% (95% CI 76.1%-84.6%)] and 3 cm [77.5% (95% CI 72.6%-81.7%)]. AUC of CT-FFR at 1 cm distal to the lesion were both highest for global level and moderately stenosis (50%-69%) lesions [0.85 (95% CI 0.81-0.89), 0.84 (95% CI 0.77-0.90)]. And the differences were statistically significant among the four measurement location groups (all P<0.05). Conclusions:The deviation of CT-FFR increases with measurement site distance distal to target lesions. One centimeter distal to the target lesion is the optimal measurement site, and the CT-FFR value here shows the highest diagnostic performance for myocardial ischemic lesions, especially for moderate stenosis.

Objective:To evaluate the effect of open reduction and internal fixation versus humeral head replacement on postoperative recovery of shoulder joint function in a population of patients with comminuted fractures of the proximal humerus. Methods:This study was a case-control study that retrospectively analyzed data from 80 patients with comminuted fractures of the proximal humerus who underwent surgical treatment at the Department of Orthopedics at Xi'an Gaoxin Hospital from January 2020 to December 2023. The patients were divided into two groups based on the surgical method: the control group ( n = 45) received open reduction and internal fixation, while the observation group ( n = 35) underwent humeral head replacement. Surgery-related indexes, as well as therapeutic effect ratings, shoulder joint mobility, and shoulder joint function 3 months post-surgery, were compared between the two groups. Additionally, the incidence of complications occurring during the treatment was also compared between the two groups. Results:In the observation group, the intraoperative blood loss, surgery duration, postoperative drainage amount, and length of hospital stay were (186.92 ± 28.04) mL, (68.89 ± 10.12) minutes, (57.89 ± 11.25) mL, and (10.18 ± 2.41) days, respectively, all of which were significantly lower than those in the control group, which were (218.23 ± 35.57) mL, (98.26 ± 15.34) minutes, (73.65 ± 13.68) mL, and (12.35 ± 2.92) days ( t = 4.27, 9.78, 5.51, 3.55, all P < 0.05). There was no statistically significant difference in the therapeutic effect between the two groups 3 months post-surgery [97.14% (34/35) vs. 95.56% (43/45), χ2 = 0.04, P > 0.05]. At 3 months post-surgery, the angles of forward elevation, external rotation, and internal rotation in the observation group were (95.42 ± 7.88)°, (61.37 ± 6.56)°, and (74.38 ± 5.01)°, respectively, while in the control group they were (93.68 ± 7.75)°, (60.42 ± 6.87)°, and (73.75 ± 4.92)°, respectively. The differences were not statistically significant between the two groups ( t = -0.98, -0.62, -0.56, all P > 0.05). At 3 months post-surgery, the shoulder function score in the observation group was (73.46 ± 9.15), which was not significantly different from that in the control group [(71.75 ± 8.66), t = -0.85, P > 0.05]. The incidence of complications in the observation group was 2.86% (1/35), which was significantly lower than that in the control group [22.22% (10/45), χ2 = 4.70, P = 0.030). Conclusions:For patients with comminuted fractures of the proximal humerus, both open reduction and internal fixation and humeral head replacement can achieve good shoulder joint function recovery. However, humeral head replacement is more advantageous than open reduction and internal fixation during the perioperative period.

Purpose/Significance To deeply analyze the research progress on the application of medical knowledge graph in the field of stroke,to discuss the problems of the development of stroke knowledge graph in China,and to put forward suggestions for the construc-tion of stroke knowledge graph.Method/Process By reviewing and analyzing the relevant literature,the application of medical knowledge graph in the field of stroke is sorted out and summarized.Result/Conclusion There are still many deficiencies in the development of stroke knowledge graph in China,and in the future,in-depth research can be carried out from four aspects,namely,expanding the ap-plication scope of knowledge graph,promoting the fusion of knowledge graph,developing more efficient algorithms,and upgrading to cog-nitive graph by joint artificial intelligence(AI).

Objective:To explore the impact of coronary CT angiography (CCTA) image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve (CT-FFR).Methods:Based on the CT-FFR CHINA trial, the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA, CT-FFR and FFR measurement. The subjective and objective assessments of CCTA image were performed on a per-vessel level. The objective assessments included the enhancement degree of coronary artery, the signal-to-noise ratio (SNR) of the aortic root. We used χ 2 test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups (non-artifact vs. artifact), enhancement degree of coronary artery groups (≤400 vs. 401-500 vs.>500 HU), SNR of the aortic root groups (≤16.9 vs.>16.9), body mass index (BMI) groups (<25 kg/m 2 vs.≥25 kg/m 2) and heart rate groups (<75 bpm vs.≥75 bpm). FFR and CT-FFR values≤0.80 was identified as myocardial ischemia. Results:The study enrolled 317 patients with 366 vessels. All target vessels in CCTA images were successfully analyzed by CT-FFR. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of the non-artifact group were 90.45%, 86.75%, 93.10%, 90.00%, 90.76% and 0.928, respectively, and those of the artifact group were 83.23%, 87.21%, 79.01%, 81.52%, 85.33% and 0.869, respectively. The differences in accuracy and specificity were statistically significant (χ 2=4.23, P=0.040; χ 2=8.55, P=0.003). The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups (all P>0.05). Conclusions:The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia. The degree of vascular enhancement, SNR, BMI, and heart rate have no significant effect on the diagnostic performance of CT-FFR.

OBJECTIVE: To investigate the association between the glucose-to-lymphocyte ratio (GLR) and prognosis of patients with sepsis-associated acute kidney injury (SA-AKI). METHODS: Based on the Medical Information Mart for Intensive Care-IV (MIMIC-IV), SA-AKI patients aged ≥ 18 years were selected. According to the tertiles of GLR, the patients were divided into GLR1 group (GLR ≤ 4.97×10^-9 mmol), GLR2 group (4.97×10^-9 mmol < GLR < 9.75×10^-9 mmol) and GLR3 group (GLR ≥ 9.75×10^-9 mmol). Patients with SA-AKI were divided into survival group and death group according to whether they survived 28 days after admission. The patient's gender, age, vital signs, laboratory test results, comorbidities, sequential organ failure assessment (SOFA), acute physiology score III (APS III) score and treatment measures were extracted from the database. Kaplan-Meier survival analysis was used to make the survival curves of patients with SA-AKI at 28 days, 90 days, 180 days and 1 year. Multivariate Logistic regression analysis model was used to explore the independent risk factors of 28-day mortality in patients with SA-AKI. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive efficacy of GLR for the prognosis of patients with SA-AKI. RESULTS: A total of 1 524 patients with SA-AKI were included, with a median age of 68.28 (58.96, 77.24) years old, including 612 females (40.16%) and 912 males (59.84%). There were 507 patients in the GLR1 group, 509 patients in the GLR2 group and 508 patients in the GLR3 group. There were 1 181 patients in the 28-day survival group and 343 patients in the death group. Grouping according to GLR tertiles showed that with the increase of GLR, the 28-day, 90-day, 180-day and 1-year mortality of SA-AKI patients gradually increased (28-day mortality were 11.64%, 22.00%, 33.86%, respectively; 90-day mortality were 15.98%, 26.72%, 40.55%, respectively; 180-day mortality were 17.16%, 28.29% and 41.73%, and the 1-year mortality were 17.95%, 29.27% and 42.72%, respectively, all P < 0.01). According to 28-day survival status, the GLR of the death group was significantly higher than that of the survival group [×10^-9 mmol: 9.81 (5.75, 20.01) vs. 6.44 (3.64, 10.78), P < 0.01]. Multivariate Logistic regression analysis showed that GLR was an independent risk factor for 28-day mortality in patients with SA-AKI [when GLR was used as a continuous variable: odds ratio (OR) = 1.065, 95% confidence interval (95%CI) was 1.045-1.085, P < 0.001; when GLR was used as a categorical variable, compared with GLR1 group: GLR2 group OR = 1.782, 95%CI was 1.200-2.647, P = 0.004; GLR3 group OR = 2.727, 95%CI was 1.857-4.005, P < 0.001]. ROC curve analysis showed that the area under the ROC curve (AUC) of GLR for predicting 28-day mortality in patients with SA-AKI was 0.674, when the optimal cut-off value was 8.769×10^-9 mmol, the sensitivity was 57.1% and the specificity was 67.1%. The predictive performance was improved when GLR was combined with APS III score and SOFA score, and the AUC was 0.806, the sensitivity was 74.6% and the specificity was 71.4%. CONCLUSIONS GLR is an independent risk factor of 28-day mortality in patients with SA-AKI, and high GLR is associated with poor prognosis in patients with SA-AKI.
Male ; Female ; Humans ; Blood Glucose ; Glucose ; ROC Curve ; Prognosis ; Sepsis/diagnosis* ; Acute Kidney Injury ; Retrospective Studies ; Intensive Care Units