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.

Objective To screen the differentially expressed proteins in glomeruli during the treatment of lupus nephritis(LN)with hydroxychloroquine sulfate(HCQ).Methods Sixty female NZB/WF1 mice were used.At the age of 28 weeks,40 mice with proteinuria of 3+to 4+were divided into HCQ and control groups.After feeding for 36 weeks,the glomerular proteins were extracted by magnetic beads and analyzed by two-dimensional fluorescence difference gel electrophoresis(2D-DIGE)and matrix-assisted laser desorption/ioniza-tion time-of-flight mass spectrometry(MALDI-TOF-MS).The expression of the candidate proteins in the glomeruli of the LN mice was exa-mined by immunohistochemistry.Results A total of 31 differentially expressed proteins were identified between the two groups,including 24 upregulated and seven downregulated proteins.Conclusion The expression of proteins like RI and ENOA in the glomeruli of LN mice was significantly different during HCQ treatment.These proteins may be involved in the pathogenesis of LN and are therefore potential targets of HCQ in the treatment of LN.

AIM:To investigate the effects of mitogen-inducible gene 6(MIG6)overexpression on palmitic acid(PA)-induced endoplasmic reticulum stress-associated steatosis in hepatocytes.METHODS:A mouse model of non-alcoholic steatohepatitis was established by feeding twenty C57BL/6J mice a high-fat diet for 26 weeks.The mice were ran-domly divided into two groups:normal diet control group and high-fat diet group,and their livers were retained for subse-quent experiments.The PA was used to induce lipid accumulation in HepG2 cells and AML12 cells,and the cells were di-vided into two groups:BSA(10%BSA)group and PA(500 μmol/L PA)group.The MIG6 overexpression was induced by transfecting HepG2 and AML12 cells with human and mouse MIG6 overexpression plasmids,respectively.The cells were divided into four groups according to their different treatment conditions:(1)negatiive+BSA group(transfected with nega-tive control plasmid+10%BSA);(2)MIG6+BSA group(transfected with MIG6 overexpression plasmid+10%BSA);(3)negative+PA group(transfected with negative control plasmid+500 μmol/L PA);(4)MIG6+PA group(transfected with MIG6 overexpression plasmid+500 μmol/L PA).Lipid accumulation in hepatocytes was assessed by oil red O staining,and RT-qPCR was used to detect the mRNA expression level of MIG6 in liver tissues.The protein levels of MIG6,lipid synthesis-related molecules fatty acid synthase(FASN)and sterol regulatory element-binding protein 1(SREBP1),and endoplasmic reticulum stress-related proteins glucose regulated protein 78(GRP78)and C/EBP homologous protein(CHOP)in hepatocytes were detected using Western blot.RESULTS:High-fat diet increased the triglyceride content in the liver tissue of C57BL/6J mice induced lipid accumulation in hepatocytes and suppressed the mRNA expression level of MIG6(P<0.01).PA intervention increased the protein levels of lipid synthesis-related molecules such as FASN and SREBP1,and endoplasmic reticulum stress markers GRP78 and CHOP in hepatocytes,but inhibited MIG6 protein levels(P<0.01).We transfected hepatocytes with MIG6 overexpression plasmid,which significantly increased MIG6 protein levels,decreased GRP78 and CHOP protein levels in hepatocytes(P<0.01),significantly attenuated PA-induced lipid accumulation in hepatocytes,and down-regulated FASN and SREBP1 protein levels(P<0.01).These results indicate that MIG6 overexpression inhibited PA-induced endoplasmic reticulum stress and attenuated lipid accumulation in hepato-cytes.CONCLUSION:Overexpression of MIG6 inhibits lipid accumulation in hepatocytes by suppressing endoplasmic reticulum stress.

Objective:To analyze the clinical characteristics and management strategy of carotid web (CW)-related stroke and improve the understanding of CW.Methods:The clinical data of 6 patients with CW-related stroke treated at Xuanwu Hospital, Capital Medical University, from January 2018 to September 2022 were retrospectively analyzed. Relevant data included clinical manifestations, bronchial magnetic resonance imaging (MRI), CT angiography (CTA)/digital subtraction angiography (DSA), carotid ultrasonography, and transcranial color-coded Doppler sonography (TCCD). Treatments and follow-ups were also reported.Results:All 6 patients were middle-aged or young, without traditional risk factors for cerebrovascular disease. The male-to-female ratio was 2∶4. All patients had recurrent strokes, with a score of 2-4 on the National Institutes of Health Stroke Scale at the time of onset. Head MRI showed 5 patients with cerebral infarction in the middle cerebral artery supply area; 1 patient had no intracranial infarction. No significant stenosis of the vessels at the site of the CW was observed in any of the 6 patients. Four patients had ipsilateral stenosis or occlusion of the middle cerebral artery, 1 patient had microembolic signals in the middle cerebral artery, and 1 patient had no significant abnormalities in the intracranial artery. All 6 patients were initially diagnosed by ultrasound. Diagnoses were confirmed by CTA/DSA in 5 cases; the other patient did not show any significant abnormalities. All 6 patients underwent a carotid endarterectomy after a pathological examination to confirm the diagnosis. Postoperatively, regular antiplatelet aggregation and statin lipid-lowering therapies were administered. A follow-up of 0.5 to 5.2 years showed no stroke recurrence in any patient.Conclusions:CW-related stroke is a rare cause of cryptogenic stroke and has a high recurrence rate. For stroke patients who do not have traditional risk factors for cerebrovascular disease while repeatedly experiencing embolic events of the internal carotid artery system, attention should be paid to the combination of the carotid and cerebral arteries, and comprehensive hemodynamic characteristics should be checked for the presence of a CW. Carotid artery ultrasound and TCCD combined with other imaging methods can improve the detection rate of a CW. Simple antiplatelet aggregation therapy cannot effectively prevent stroke recurrence. For patients with confirmed CW-related cerebral infarction, surgical resection can be performed, and the treatment effect can be evaluated using ultrasonography.

Public hospitals stand in need of strengthening cost control and improving operational efficiency to balance public welfare and economic benefits.Taking practice and exploration of ultrasound department as an exam-ple,it integrates the advantages of TDABC with cost management.Take the merits of time driver and activity driver,realizes direct cost accounting under the clinical pathway,strengthen capacity management capabilities un-der the integration of industry and finance,with a view to providing a powerful cost control tool for public hospitals to sensibly respond to pricing reform and reasonably make operational decisions.

Objective To investigate the feasibility of Doppler ultrasonography in evaluating the vulnerability of carotid atherosclerotic plaque prospectively. Method A total of 44patients (46plaques) who performed carotid endarterectomy were continuously enrolled in the Department of Neurosurgery of the First Affiliated Hospital of Soochow University from March 2019 to October 2019. Several examinations such as carotid Doppler ultrasonography (CDU) , CT angiography, CT perfusion imaging, and/or digital subtraction angiography were scheduled conventionally before surgery. Pathologic examination, including the plaque morphology, histopathologic hematoxylin eosin(HE) staining, and immunohistochemical CD31 staining, were evaluated after surgery. The plaque vulnerable score was calculated based on the parameters of CDU consisting of plaque morphology, characteristic of echo, fiber cap integrity, presence of ulcer, degree of vascular stenosis, assigned with 0 to 3 points, respectively. The plaque was defined as the vulnerable plaque if vulnerable score was more than 4, otherwise, the plaque was the stable plaque. Then the plaques were divided into vulnerable group ( n =36) and stable group ( n = 10) according to the pathological results. The patients were divided into the stroke group ( n = 33) and the non-stroke group (n = 11) based on the incidence of ischemic stroke within the last 6 months. The evaluation of neovascularization in the plaque was referring to the immunohistochemical CD31 staining. The independent-sample t test, Wilcoxon rank-sum test, and χ2test were used to compare the differences between the two groups in general data, laboratory tests, clinical symptoms, vulnerable scores, and the rates of vulnerable plaques. Kappa value was used to evaluate the consistency between CDU and histopathological HE staining in the evaluation of plaque vulnerability. Results ( 1) The differences in the National Institute of Health stroke scale score and neurological symptoms between the vulnerable group and stable group were statistically significant (all P < 0. 05). (2) The vulnerable score was significantly different between the vulnerable group and stable group (6.00 [5.00,7.00] scores vs. 4.00 [4.00,4.25] scores, P<0.01), and between the stroke group and non-stroke group (6.00 [5.00,7.00] scores vs. 4.00 [4.00,5.00] scores, P = 0.002). (3) Diagnostic efficacy: compared with histopathologic results, the sensitivity and specificity of CDU were respectively 88.9% and 8/10, positive predictive value was 94. 1% .negative predictive value was 8/12, and the Youden index was 68. 9%. The consistency between CDU and histopathological HE staining was strong ( Kappa = 0. 642, P < 0. 01). (4) Neovascularization; immunohistochemical CD31 staining showed neovascularization in vulnerable plaque; the microvessel density in vulnerable group was higher than that in stable group([2. 84 ± 1. 56] mm3vs. [ 1. 38 ±0. 61 ] mm3). (5) The relationship between plaque vulnerability score and ischemic stroke: the rates of vulnerable plaques in the stroke group was higher than that in the non-stroke group (88. 6% [31/35 ] vs. 3/11 ;χ2= 13. 286, P < 0. 01 ). Conclusion The plaque vulnerable score evaluating by vascular ultrasound can accurately and quantitatively assess the vulnerability of carotid plaques, and angiogenesis can be observed in the vulnerable plaque, which provides a theoretical basis for clinical diagnosis and accurate treatment.

Objective:To describe the COVID-19 epidemic and its characteristics in Heilongjiang province, and provide evidence for the further prevention and control of COVID-19 in the province.Methods:The information of COVID-19 cases and clusters were collected from national notifiable disease report system and management information system for reporting public health emergencies of China CDC. The Software’s of Excel 2010 and SPSS 23.0 were applied for data cleaning and statistical analysis on the population, time and area distributions of COVID-19 cases.Results:On January 22, 2020, the first confirmed case of COVID-19 was reported in Heilongjiang. By March 11, 2020, a total of 482 cases domestic case of COVID-19, The incidence rate was 1.28/100 000, the mortality rate was 2.70% (13/482) in 13 municipalities in Heilongjiang. There were 81 clusters of COVID-19, The number of confirmed cases accounted for 79.25% (382/482) of the total confirmed cases and 12 cases of deaths. The family clusters accounted for 86.42% (70/81). Compared with the sporadic cases, the mortality rate, proportion of elderly cases aged 60 or above and severe or critical cases of clinical classification were all higher in the clusters especially the family clusters, but the differences were not significant ( P>0.05). There were 34 clusters involving more than 5 confirmed cases accounted for 41.98% (34/81) of the total clusters, the involved cases accounted for 68.31% (261/382) of the total cases of clusters. There were significant differences in age distribution of the cases among the case clusters with different case numbers. In the clusters involving 6-9 cases, the proportion of cases aged 65 years or above was more (26.53%, 39/147). Conclusions:The incidence rate of COVID-19 was relatively high and the early epidemic was serious in Heilongjiang, The number of cases was large in clusters especially family clusters.

Objective To understand current reality of institutional elderly care services in 11 districts in Shanghai and discuss solutions to the planning and enhancement of such institutions. Methods Surveys were conducted in 20 elderly care institutions in Shanghai from August to October 2017 and questionnaires were distributed to the staff and residents in these facilities. Data were analyzed using Stata 12. 0. Results All the 20 institutions offer medical and nursing care, 19 of which providing insurance settlement and 10 were in deficit. Public facilities boost larger scale than private ones. A survey of 186 staff indicated that only 59. 67% of them felt satisfied with their academic title and professional career promotion opportunities; of 450 of the residents surveyed, 61. 47% of them expressed high acceptance of institutional elderly care, and the coverage of such insurances as critical illness and long-term care insurance was below 7%. Conclusions Half of the sample institutions experienced financial difficulties, roadblocks for staff professional promotion mechanism, unaffordable economic burden for residents, and insufficient supplementary insurance coverage. Policies should be implemented to ensure infrastructure and talent cultivation at elderly care facilities. Combination of elderly care with medical services should be promoted. Supplementary insurance is recommended for citizens to relieve disease and elderly care burden.

Objective To investigate the dynamic changes of microglial polarization at the perihe-matoma area and provide timepoint evidence for interventing microglial polarization as well as studying the polarization mechanism after intracerebral hemorrhage ( ICH ) . Methods Healthy male Sprague Dawley (SD) rats were randomly divided into sham group,ICH-4 h,1 d,3 d,7 d and 14 d groups with 6 in each group. The rats in ICH groups were injected collagenase VII-s into the caudate nucleus to establish the in-tracerebral hematoma model and rats in sham operated group were treated with the same amount of saline. The brains were taken at 4 h,1 d,3 d,7 d,14 d in the ICH group,1 d in sham group. Microglia typeⅠ( M1, CD11b++CD86+) and microglia typeⅡ( M2,CD11b++Arg-1+) were examined by immunofluorescence and the number of M1 and M2 around hematoma were analyzed. Results ( 1) The M1 and M2 were both ob-served at 4 h after ICH and a small quantity of branches were still presented on M1. ( 2) M1 took the main position in acute stage (1~3 d),early subacute stage(3~7 d) and chronic stage (>14 d) after ICH.The number of M2 was elevated transiently in superacute (<24 h) and late subacute stage (7 d).The number of M2 (31.40±1.69) was more than M1 (21.43±1.81) at 4 h after ICH ( t=- 4.085, P=0.002),and the number of M2 (116.25±5.06) significantly exceeded M1 (85.75±7.32) again on day 7 ( t=-0.690, P=0.001). Conclusion M1 is in a dominant position in acute,early subacute and chronic stages after ICH;M2 is dominant in superacute and late subacute stages. Investigating the mechanism of M2 formation at acute period ( such as 4 h) or late subacute stage ( such as 7 d) ,and inhibiting M1 formation in the early subacute stage ( 1~3 d) have important significance for clinical treatment of ICH.

Objective To detect the physical and psychological function of traditional Chinese emotional nursing versus normal nursing on coronary heart disease patients. Methods Searching the major clinical databases of Cochrane library, PubMed, China National Knowledge Infrastructure, Wanfang database and VIP database to collect the relevant randomized controlled trial (RCT) about routine nursing combined with traditional Chinese medicine emotion care on coronary heart disease. After study selection, assessment and data extraction for RCT according to the inclusion and exclusion criteria, Meta-analysis were performed by using the RevMan5.2 software. Results Fourteen relevant studies as much as 1 164 patients were included in the study. Compared with the normal therapy, the figures support that the Chinese medicine emotional care group had a better curative effect (Z=6.74, P<0.01, OR=0.21, 95%CI:0.15-0.26), and the score of Hamilton Depression Scale (Z=8.84, P<0.01, MD=6.64, 95%CI:5.11-8.18), Self-Rating Depression Scale (Z=4.79, P<0.01, MD=8.21, 95%CI:4.89-11.66), and Self-Rating Anxiety Scale (Z=11.15, P < 0.01, MD=8.23, 95%CI:6.79-9.68) were all significantly decreased. Conclusions Compared to the conventional nursing combined with traditional Chinese emotional nursing and coronary heart diseaseroutine nursing care, the degree of depression and anxiety in patients is decreased significantly, and the total clinical efficacy is dramatically increased. However, the original study of quality constraints, muchmore high-quality, large sample of RCT is needed for further demonstration.