OBJECTIVE To investigate the protective effect of 2-dodecyl-6-methoxy-2，5-diene-1，4-cyclohexanedione （DMDD）， an active component from Averrhoa carambola root， on myocardial injury in diabetic mice based on the nuclear receptor coactivator 4/ferritin heavy chain 1/autophagy-related protein 8 （NCOA4/FTH1/ATG8） axis. METHODS The successfully modeled diabetic mice were randomly divided into model group and DMDD low-， medium-， and high-dose （12.5， 25， 50 mg/kg） groups， while an additional non-modeled control group was established， with 6 mice in each group. Each group received the corresponding drug solution or an equal volume of normal saline intragastically once daily for 21 consecutive days. After the administration， the levels of fasting blood glucose （FBG）， serum lactate dehydrogenase （LDH）， and creatine kinase isoenzyme MB （CK-MB） were measured. Myocardial pathological changes， degree of fibrosis， and myocardial cell ultrastructure were observed. Myocardial cell death index and NCOA4 protein positive index were detected. The protein expression levels of NCOA4， FTH1， ATG8， solute carrier family 7 member 11 （SLC7A11）， and glutathione peroxidase 4 （GPX4） in cardiac tissue were measured. RESULTS Compared with model group， each DMDD group showed significant alleviation of cardiac pathological injury and varying degrees of improvement in the myocardial cell ultrastructure. The FBG and serum LDH and CK-MB levels， the myocardial cell death index and NCOA4 protein positive index，the protein expression levels of NCOA4， FTH1， and ATG8 in cardiac tissue were significantly decreased （ P ＜0.001）， while the protein expression levels of SLC7A11 and GPX4 were significantly increased （ P ＜0.001）. CONCLUSIONS DMDD can reduce blood glucose levels， alleviate myocardial histopathological injury， and inhibit cell death in diabetic mice. The mechanism is associated with inhibiting excessive activation of the NCOA4/FTH1/ATG8 axis and reducing ferritinophagy.

Hospice care services provide physical, emotional and sometimes spiritual care for a terminally ill patient, and community-home hospice care is one of the main service modes. The study analyzed the community-home hospice care services conducted by Minglou and Zhonghe Community Health Service Centers of Yinzhou District in Ningbo city using SWOT analysis method, presenting theadvantages and disadvantages, the opportunities and challenges of the services, and also put forward the countermeasures and suggestions for further improvement. The study may provide reference for the implementation and promotion of home hospice service in China.

Objective:To investigate whether neoadjuvant therapy can improve the prognosis of patients with pancreatic cancer.Methods:A retrospective case-control study analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database on 12, 103 patients who underwent surgical treatment between January 1, 2010, and December 31, 2021. Patients were divided into the neoadjuvant therapy group ( n=3 276) and the upfront surgery group ( n=8 827) based on whether they received neoadjuvant treatment. The neoadjuvant therapy group included 2 342 patients receiving neoadjuvant chemotherapy and 934 patients receiving neoadjuvant chemoradiotherapy. The upfront surgery group consisted of 4 335 patients receiving adjuvant chemotherapy, 1 987 patients receiving adjuvant chemoradiotherapy, 63 patients receiving adjuvant radiotherapy, and 2 442 patients undergoing surgery alone. Propensity score matching was used to eliminate group differences and create a cohort with no statistical differences in other clinicopathological features except for the grouping variable. Variables such as age, gender, tumor location, race, population of residence, tumor diameter, household income, TNM stage, and information on radiotherapy and chemotherapy were used for 1∶1 case matching. T stage, N stage, and the use of radiotherapy or chemotherapy were matched exactly. After matching, 1 182 patients were included in each group: the neoadjuvant therapy group contained 1 155 patients receiving neoadjuvant chemoradiotherapy and 27 receiving neoadjuvant chemotherapy, while the upfront surgery group comprised 848 patients receiving adjuvant chemotherapy and 334 receiving adjuvant chemoradiotherapy. TNM staging was reported according to the 7th edition of the AJCC guidelines. The primary outcome was overall survival. Measurement data with skewed distributions were expressed as M( Q1, Q3), and intergroup comparisons were conducted using the Wilcoxon rank-sum test. Categorical data were compared using the chi-square test or the Fisher′s exact test. The Log-rank test and subgroup analyses to assess interactions between neoadjuvant therapy and subgroup in COX regression models were used to compare survival benefits across variables. Landmark analysis was performed to create segmented survival curves, studying the impact of neoadjuvant therapy on prognosis during different follow-up periods. Results:The neoadjuvant therapy group had a higher proportion of T 4 tumor involving celiac axis, superior mesenteric artery, and/or common hepatic artery compared to the upfront surgery group (14.7% vs 2.8%, P<0.001). Additionally, significant differences were observed between groups in terms of race, location, population of residence, age, tumor diameter, tumor stage, and adjuvant therapy regimen ( P<0.05). The median overall survival time in the neoadjuvant therapy group was 30 months, compared to 22 months in the upfront surgery group ( P<0.001). In the neoadjuvant therapy group, the median survival was 30 months for both neoadjuvant chemotherapy and chemoradiotherapy patients; in the upfront surgery group, it was 26 months for both adjuvant chemotherapy and chemoradiotherapy patients, 17 months for adjuvant radiotherapy patients, and 12 months for surgery-only patients. After propensity score matching, there were no differences in the distribution of clinical characteristics between groups ( P>0.05), and all patients in the matched cohort had received chemotherapy. The matched neoadjuvant therapy group had a longer median overall survival compared to the upfront surgery group (30 months vs 27 months, P<0.001). Subgroup interaction analysis revealed that T stage had a significant interaction with neoadjuvant therapy, both before (T 4 stage: HR=0.382, 95% CI: 0.319-0.458; T 2-T 3 stages: HR=0.696, 95% CI: 0.656-0.738; T 1 stage: HR=1.199, 95% CI: 0.867-1.657; interaction P<0.001) and after matching (T 4 stage: HR=0.581, 95% CI: 0.414-0.814; T 2-T 3 stages: HR=0.827, 95% CI: 0.734-0.931; T 1 stage: HR=1.320, 95% CI: 0.716-2.433; interaction P=0.043). Subgroup interaction analysis indicated that T 1 patients did not benefit from neoadjuvant therapy; survival curves plotted for matched T 1 patients showed no difference in survival between the neoadjuvant therapy group and the upfront surgery group ( P=0.323). Conversely, non-T 1 (T 2-T 4) stage patients showed significant survival benefits in both unmatched and matched cohorts ( P<0.001). Landmark analysis showing that the survival benefits occurred mainly in the early postoperative period of up to 3 years ( P<0.001), but there was no difference in overall survival between the neoadjuvant therapy group and the upfront surgery group of >3 years ( P>0.05). Patients with Arterial invasion (T 4 stage compared to T 1-T 3 stages) showed a similarly significant interaction with the benefit of neoadjuvant therapy in both the pre-matching cohort (interaction P<0.001) and the post-matching cohort (interaction P=0.037). Patients with T 4 stage disease in the neoadjuvant therapy group had longer overall survival compared to the upfront surgery group (median overall survival in pre-matching cohort: 30 months vs 13 months, P<0.001; median overall survival in post-matching cohort: 28 months vs 18 months, P=0.001). Among T 4 stage patients in the post-matching cohort, neoadjuvant therapy provided significant survival benefits during the early postoperative period of up to 3 years ( P=0.001). However, there was no difference in overall survival between the neoadjuvant therapy group and the direct surgery group beyond 3 years( P=0.729). Conclusions:The prognosis in the neoadjuvant therapy group was better than in the upfront surgery group. Propensity score matching and subgroup interaction analysis showed that non-T 1 and T 4 stage patients benefited more from neoadjuvant therapy, with benefits mainly seen in the early postoperative period (≤3 years).

Cellular senescence, stable cell cycle arrest that can be triggered in normal cells in response to various intrinsic and extrinsic stressors, has been highlighted as one of the most important mechanisms involved in kidney diseases. It not only serves as a fundamental biological process promoting normal organogenesis and successful wound repair but also contributes to organ dysfunction, tissue fibrosis, and the generalized aging phenotype. Moreover, senescent cells exhibit reduced regenerative capacity, which impairs renal function recovery from injuries. Importantly, senescent cells are involved in immune regulation via secreting a diverse array of proinflammatory and profibrotic factors known as senescence-associated secretory phenotype (SASP) with autocrine, paracrine, and endocrine activities. Thus, eliminating detrimental senescent cells or inhibiting SASP production holds great promise for developing innovative therapeutic strategies for kidney diseases. In this review, we summarize the current knowledge of the intricate mechanisms and hallmarks of cellular senescence in kidney diseases and emphasize novel therapeutic targets, including epigenetic regulators, G protein-coupled receptors, and lysosome-related proteins. Particularly, we highlight the recently identified senotherapeutics, which provide new therapeutic strategies for treating kidney diseases.
Humans ; Cellular Senescence/genetics* ; Kidney Diseases/pathology* ; Senescence-Associated Secretory Phenotype/physiology* ; Animals ; Epigenesis, Genetic/physiology*

Objective:To evaluate the application effect of a wearable visual field meter based on extended reality (XR) glasses for patients with macular disease.Methods:A self-controlled study was conducted.A total of 41 consecutive patients (41 eyes) with macular disease were recruited at Renmin Hospital of Wuhan University from October 2022 to October 2024.All patients underwent 10-2 center visual field test using a self-developed wearable visual field meter (XRVF), and the results were compared with those obtained using a traditional Humphrey field analyzer (HFA).The comparison parameters included mean retinal sensitivity (MS), false positive rate (FPR), false negative rate (FNR), and testing duration.A subject satisfaction questionnaire was administered.This study followed the Declaration of Helsinki.The study protocol was approved by the Medical Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2024-K263), and all subjects signed the informed consent form.Results:The retinal sensitivity of patients measured by HFA was (23.24±3.71)dB, which was higher than (22.01±3.45)dB by XRVF, showing a statistically significant difference ( t=4.924, P=0.036).The FPR measured by HFA and XRVF were (2.39±2.51)% and (2.59±3.29)%, respectively, and the FNR were (3.49±6.05)% and (3.74±5.38)%, respectively, showing no statistically significant difference ( t=-3.624, P=0.948; t=-1.241, P=0.519).The median test duration for HFA and XRVF was 6.15 (5.78, 6.65) and 5.98 (5.71, 6.69)minutes, respectively, without statistically significant difference ( Z=-1.987, P=0.953).92.6% of the subjects thought the device was comfortable, simple and practical. Conclusions:The XRVF has good consistency with the HFA, can effectively and reliably evaluate the visual field function of patients with macular disease, and is easily accepted by patients.

Objective:To develop a Recurrence Fear Scale for Patients with Atrial Fibrillation after Catheter Ablation and conduct psychometric testing for its reliability and validity.Methods:Based on the common-sense model of self-regulation, the scale was developed through a literature review and semi-structured interviews to construct an item pool. The scale draft was formed through expert consultation and a pre-survey. Using convenience sampling, 361 patients with atrial fibrillation who had undergone catheter ablation and were either hospitalized or attending outpatient follow-up at the Department of Cardiology, Affiliated Hospital of Qingdao University, between January and March 2024, were selected for questionnaire survey. Item analysis and reliability and validity tests were performed on the scale.Results:Exploratory factor analysis identified five common factors, with a cumulative variance contribution rate of 74.375%. Confirmatory factor analysis showed good model fit. The final scale included five dimensions and 24 items: trigger factors, recurrence risk perception, disease uncertainty, psychological burden, and coping strategies. The content validity index at the scale level was 0.864, and the item-level content validity index ranged from 0.684 to 0.947. The Cronbach's α coefficient of the scale was 0.919, the split-half reliability coefficient was 0.834, and the test-retest reliability coefficient was 0.872.Conclusions:The development of the Recurrence Fear Scale for Patients with Atrial Fibrillation after Catheter Ablation is scientific and standardized, and the scale has good reliability and validity. It can effectively assess the level of recurrence fear in these patients.

Objective:To evaluate the application effect of a wearable visual field meter based on extended reality (XR) glasses for patients with macular disease.Methods:A self-controlled study was conducted.A total of 41 consecutive patients (41 eyes) with macular disease were recruited at Renmin Hospital of Wuhan University from October 2022 to October 2024.All patients underwent 10-2 center visual field test using a self-developed wearable visual field meter (XRVF), and the results were compared with those obtained using a traditional Humphrey field analyzer (HFA).The comparison parameters included mean retinal sensitivity (MS), false positive rate (FPR), false negative rate (FNR), and testing duration.A subject satisfaction questionnaire was administered.This study followed the Declaration of Helsinki.The study protocol was approved by the Medical Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2024-K263), and all subjects signed the informed consent form.Results:The retinal sensitivity of patients measured by HFA was (23.24±3.71)dB, which was higher than (22.01±3.45)dB by XRVF, showing a statistically significant difference ( t=4.924, P=0.036).The FPR measured by HFA and XRVF were (2.39±2.51)% and (2.59±3.29)%, respectively, and the FNR were (3.49±6.05)% and (3.74±5.38)%, respectively, showing no statistically significant difference ( t=-3.624, P=0.948; t=-1.241, P=0.519).The median test duration for HFA and XRVF was 6.15 (5.78, 6.65) and 5.98 (5.71, 6.69)minutes, respectively, without statistically significant difference ( Z=-1.987, P=0.953).92.6% of the subjects thought the device was comfortable, simple and practical. Conclusions:The XRVF has good consistency with the HFA, can effectively and reliably evaluate the visual field function of patients with macular disease, and is easily accepted by patients.

Objective:To develop a Recurrence Fear Scale for Patients with Atrial Fibrillation after Catheter Ablation and conduct psychometric testing for its reliability and validity.Methods:Based on the common-sense model of self-regulation, the scale was developed through a literature review and semi-structured interviews to construct an item pool. The scale draft was formed through expert consultation and a pre-survey. Using convenience sampling, 361 patients with atrial fibrillation who had undergone catheter ablation and were either hospitalized or attending outpatient follow-up at the Department of Cardiology, Affiliated Hospital of Qingdao University, between January and March 2024, were selected for questionnaire survey. Item analysis and reliability and validity tests were performed on the scale.Results:Exploratory factor analysis identified five common factors, with a cumulative variance contribution rate of 74.375%. Confirmatory factor analysis showed good model fit. The final scale included five dimensions and 24 items: trigger factors, recurrence risk perception, disease uncertainty, psychological burden, and coping strategies. The content validity index at the scale level was 0.864, and the item-level content validity index ranged from 0.684 to 0.947. The Cronbach's α coefficient of the scale was 0.919, the split-half reliability coefficient was 0.834, and the test-retest reliability coefficient was 0.872.Conclusions:The development of the Recurrence Fear Scale for Patients with Atrial Fibrillation after Catheter Ablation is scientific and standardized, and the scale has good reliability and validity. It can effectively assess the level of recurrence fear in these patients.

Hospice care services provide physical, emotional and sometimes spiritual care for a terminally ill patient, and community-home hospice care is one of the main service modes. The study analyzed the community-home hospice care services conducted by Minglou and Zhonghe Community Health Service Centers of Yinzhou District in Ningbo city using SWOT analysis method, presenting theadvantages and disadvantages, the opportunities and challenges of the services, and also put forward the countermeasures and suggestions for further improvement. The study may provide reference for the implementation and promotion of home hospice service in China.

BACKGROUND:De novo adipose regeneration induced by small extracellular vesicles has become a promising method for repairing soft tissue defects.However,due to different animal models and small extracellular vesicle application dosages,it is difficult to quantitatively compare the therapeutic effect of small extracellular vesicles from various sources on adipose regeneration. OBJECTIVE:To compare the regenerative effects of small extracellular vesicles derived from stem cells and small extracellular vesicles from tissue. METHODS:Small extracellular vesicles derived from adipose-derived stem cells and from adipose tissue were isolated by ultracentrifugation.The particle number,particle size,morphology,and protein expression of small extracellular vesicles were identified by nanoparticle tracking analysis,transmission electron microscopy and western blot assay.A quantitative and evaluative subcutaneous model for adipose regeneration in C57 mice was established using a customized silicone tube.The regenerative effects of induced de novo adipose were compared by cell counting and hematoxylin-eosin staining. RESULTS AND CONCLUSION:(1)Small extracellular vesicles derived from adipose-derived stem cells and from adipose tissue were isolated by ultracentrifugation.Both small extracellular vesicles were round-shape in transmission electron microscopy with particle size between 50-200 nm,and abundant with the small extracellular vesicles marker protein CD81,CD63 and TSG101.(2)An equal number of small extracellular vesicles were mixed with matrigel in customized silicone tubes,implanted subcutaneously in the back of mice to establish a cell-free and quantifiable adipose regeneration model.(3)On days 3 and 7 after implantation,the results of cell counting and hematoxylin-eosin staining showed that both small extracellular vesicle groups recruited more host cells than the blank group,and the small extracellular vesicles derived from adipose tissue group were superior to the small extracellular vesicles derived from adipose-derived stem cell group.(4)4 weeks after implantation,hematoxylin-eosin staining of the contents in silicone tubes showed that small extracellular vesicles induced de novo adipose regeneration in vivo,and the small extracellular vesicles derived from adipose tissue group were superior to the small extracellular vesicles derived from adipose-derived stem cell group.The above results indicated that small extracellular vesicles derived from tissues have a superior effect on inducing de novo adipose regeneration compared to small extracellular vesicles derived from stem cells.