Type 1 diabetes mellitus is a chronic autoimmune disease caused by the destruction of pancreatic islet β cells. Pancreatic islet transplantation provides a treatment method for patients with type 1 diabetes mellitus to restore endogenous insulin secretion. However, some problems limit the widespread application of islet transplantation, such as the shortage of donors and post-transplantation rejection damage. Mesenchymal stem cell-derived exosome (MSC-Exo) has become a potential tool for islet transplantation therapy due to their immunomodulatory and tissue repair capabilities. MSC-Exo shows great promise for application, because of low immunogenicity, easily being stored and transported, and the potential as drug delivery vehicles. However, challenges such as preparation, purification, standardization and safety verification need to be overcome before converting MSC-Exo into clinical practice. Therefore, this article reviews the application and potential advantages of MSC-Exo in islet transplantation, aiming to providing more effective and safer treatment options for patients with type 1 diabetes mellitus.

Objective: To explore the safety and feasibility of the disconnection of the left renal artery preferentially during robot-assisted inferior vena cava (IVC) thrombectomy for patients with left renal cell carcinoma and tumor emboli. Methods: Clinical data of 7 patients who underwent robot-assisted IVC thrombectomy and radical nephrectomy in the First Affiliated Hospital of Zhengzhou University during Dec.2021 and Oct.2024 were retrospectively analyzed.Thrombectomy was performed first，followed by nephrectomy. The “IVC-first, kidney-last”robotic technique was developed to minimize chances of IVC thrombus. When patients in left lateral decubitus position, the left renal artery was severed from the right side through the inferior vena cava and abdominal aorta. After removal of thrombus from IVC was completed, patients changed to the right lateral position to complete radical left nephrectomy. Results: Imaging examinations revealed that the median diameter of the renal cell carcinomas was 83(46-99) mm; the median length of the inferior vena cava cancerous emboli was 49(2-91) mm.According to the Mayo classification，the cancerous emboli were gradeⅠ in 2 cases，gradeⅡ in 4 cases，and grade Ⅲ in 1 case.All surgeries were successful.The median operation time was 248(201-331) minutes，blood loss 500(200-1000) mL，and 6 cases required intraoperative blood transfusion.The median time for transition into the intensive care unit was 1(1-4) days，and drainage tube removal 6(5-12) days.Serum creatinine increased significantly in 5 cases，4 of which returned to normal after 1 week，but 1 had renal insufficiency (creatinine 166 μmol/L).Chylous fistula occurred in 1 patient，and lower extremity venous thrombosis developed in 3 patients.Pathological examinations indicated 6 cases of renal cell carcinoma and 1 case of MiT family translocation renal cell carcinoma.During the median follow-up of 17(1-35) months，5 cases were tumor-free，while 2 had lung and retroperitoneal metastases.They received targeted therapy of axitinib combined immunotheraphy and lived with tumors. Conclusion: In the left lateral position for left renal cell carcinoma with cancerous emboli，robot-assisted laparoscopic thrombectomy by crossing the inferior vena cava and abdominal aorta and disconnecting the left renal artery first is safe and feasible.

Objective:To discuss the changes of adenosine deaminase 2(ADA2)activity in the serum of the systemic lupus erythematosus(SLE)patients,and to clarify its clinical value in the diagnosis and disease assessment of the SLE patients.Methods:According to the inclusion and exclusion criteria,69 SLE patients(SLE group)and 69 healthy controls(control group)were enrolled as study subjects.The disease activity of SLE patients was evaluated by SLE Disease Activity Index(SLEDAI).The ADA2 activity in the serum of the subjects in both groups was detected.The patients were further divided into subgroups based on the presence or absence of the following clinical symptoms:arthritis,myositis,hematuria,proteinuria,pyuria,alopecia,new rash,mucosal ulcer,pleuritis,hypocomplementemia,elevated anti-double-stranded DNA(anti-dsDNA)antibody,thrombocytopenia,and leukopenia.The differences in serum ADA2 activity between joint symptomatic group and joint asymptomatic group were analyzed.The diagnostic efficacy of serum ADA2 activity was evaluated by receiver operating characteristic(ROC)curve analysis.The correlation between ADA2 activity and disease activity in the SLE patients was analyzed by Spearman correlation analysis.Results:Compared with control group,the ADA2 activity in the serum of the patients in SLE group was significantly increased(P<0.01).The ROC analysis results showed that when the cut-off value of ADA2 activity was set at 8.5 U·L-1,the diagnostic performance was optimal,with an area under the curve(AUC)of 0.879(95%CI:0.817-0.940),the specificity was 89.86%,and the sensitivity was 75.36%.The serum ADA2 activity was positively correlated with disease activity in the SLE patients(r=0.32,P=0.007).The subgroup analysis of clinical symptoms results showed that the serum ADA2 activity in the SLE patients with symptoms was significantly higher than that in the SLE patients without symptoms(P<0.01).No significant differences were observed in serum ADA2 activity between the SLE patients with and without myositis,hematuria,proteinuria,pyuria,alopecia,new rash,mucosal ulcer,pleuritis,hypocomplementemia,elevated anti-dsDNA antibody,thrombocytopenia,or leukopenia(P>0.05).Conclusion:The serum ADA2 activity is increased in the SLE patients and can serve as a diagnostic marker for SLE.Serum ADA2 activity is positively correlated with disease activity and is associated with arthritis in the SLE patients,suggesting its potential as an indicator for disease assessment and monitoring.

Objective:To develop and evaluate a nomogram prediction model for poor outcome of lower extremity motor function in patients with acute ischemic stroke (AIS) at 90 days after onset.Methods:Patients with AIS admitted to Guangzhou Province Hospital of Chinese Medicine from January to October 2024 were included retrospectively. At 90 days after onset, Functional Ambulation Category (FAC) was used for outcome evaluation. ≥4 was defined as good outcome and <4 was defined as poor outcome. Multivariate logistic regression analysis was used to identify the independent predictive factors for poor outcome of lower extremity motor function, and develop a nomogram prediction model. The area under the receiver operating characteristic curve, calibration curve, and clinical decision curve were used to evaluate the predictive model. Results:A total of 325 patients with AIS were enrolled, including 214 males (65.8%), median aged 62 years (interquartile range, 54-71 years); 158 patients (48.6%) had poor outcome of lower extremity motor function. Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.037, 95% confidence interval [ CI] 1.011-1.065]; P=0.007) and a higher baseline National Institutes of Health Stroke Scale (NIHSS) score ( OR 1.472, 95% CI 1.336-1.637; P<0.001) were the independent predictors of poor outcome, while intravenous thrombolysis ( OR 0.195, 95% CI 0.080-0.443; P<0.001) and early rehabilitation intervention ( OR 0.444, 95% CI 0.231-0.850; P=0.014) were the independent predictors of good outcome. The area under the receiver operating characteristic curve of the nomogram prediction model developed using the above factors was 0.906 (95% CI 0.872-0.940), indicating that the model had good discriminability. The calibration curve fits well with the ideal curve. The clinical decision curve showed that the model had stronger clinical practicality. Conclusion:The nomogram developed by age, intravenous thrombolysis, early rehabilitation intervention, and baseline NIHSS score can effectively predict the risk of poor outcome of lower extremity motor function in patients with AIS and has higher clinical value.

Objective:To investigate the effects of dexmedetomidine (DEX) in different doses on circulation fluctuation, anesthesia depth, muscle relaxation and safety during adrenal pheochromocytoma resection.Methods:A total of 78 patients undergoing adrenal pheochromocytoma resection in Shangqiu First people’s Hospital and and the First Affiliated Hospital of Zhengzhou University from Sep.2020 to Sep.2022 were prospectively selected and divided into two groups with 39 cases in each group by random number table method. The 0.2 μg group were given 0.2 μg·kg -1 ·h -1 DEX 30min before general anesthesia induction, and the 0.4 μg group were given 0.4 μg·kg -1 ·h -1 DEX 30min before general anesthesia induction until tumor vessels were completely clamped. The time cycle fluctuation (heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO 2) ), anesthesia depth, muscle relaxation effect, anesthesia recovery, vasoactive drug use and safety of the two groups were compared. Results:After induction of anesthesia and the end of surgery,HR in the 0.4 μg group was (92.73±9.58) bpm and (84.39±8.65) bpm, both lower than HR in the 0.2 μg group of (103.57±6.91) bpm and (91.53±7.27) bpm, respectively. MAP was (85.30±4.29) mmHg and (80.45±6.38) mmHg, both lower than MAP in the 0.2 μg group of (96.35±5.88) mmHg and (84.92±5.19) mmHg, respectively. After tumor resection, HR and MAP were (80.22±7.30) bpm and (77.46±7.10) mmHg, both higher than the HR and MAP in the 0.2 μg group of (75.14±5.82) bpm and (73.92±6.03) mmHg, respectively ( P<0.05). NI immediately after endotracheal intubation in the 0.4 μg group was (52.23±5.40), lower than that in the 0.2 μg group (58.78±5.92) ( P<0.05) ; The onset time in the 0.4 μg group was (91.00±10.00) s, earlier than that in the 0.2 μg group (105.00±12.00) s ( P<0.05) ; SAS score at tracheal extubation in the 0.4 μg group was 5 (4, 5), lower than that in the 0.2 μg group (4, 3, 4) ( P<0.05) ; The doses of phentolamine, norepinephrine, and nitroglycerin in the 0.4 μg group were (2.64±0.35) mg, (60.42±8.57) μg, and (102.00±12.31) μg/kg·min, respectively, all lower than those in the 0.2 μg group (3.79±0.44) mg, (78.70±10.28) μg, and (113.25±19.67) μg/kg·min ( P<0.05). There was no significant difference in the total incidence of adverse reactions between the 0.4 μg group and the 0.2 μg group ( P>0.05) . Conclusion:The use of 0.2 μg·kg -1 ·h -1 and 0.4 μg·kg -1 ·h -1 DEX in the resection of pheochromocytoma has high safety. The latter has better anesthetic effect, can reduce the dose of vasoactive drugs, improve the state of muscle relaxation, and help maintain the stability of circulation.

Objective:To analyze the clinical outcomes of initial radioactive iodine 131I therapy (RIT) for patients with familial differentiated thyroid cancer (FDTC) and sporadic differentiated thyroid cancer (SDTC), along with their influencing factors. Methods:The clinical data of 120 FDTC and 480 SDTC patients who received RIT at the Department of Nuclear Medicine, Tianjin Medical University General Hospital from January 2016 to January 2022 were retrospectively analyzed. These patients, categorized into the FDTC and SDTC groups, were further divided into three subgroups based on their response to initial RIT: no evidence of disease (NED), biochemical persistence of disease (BPD), or structural/functional persistence of disease (S/FPD). For the NED subgroup, the disease-free survival (DFS) was analyzed. For the BPD and S/FPD subgroups, the progression-free survival (PFS) was investigated. Furthermore, risk factors for failure to reach the NED status were identified.Results:After initial RIT, 56 (46.7%), 50 (41.7%), 14 (11.6%) patients in the FDTC group reached the NED, BPD, and S/FPD statuses, respectively, while 284 (59.1%), 160 (33.3%), 36 (7.5%) and SDTC patients in the SDTC group were in the NED, BPD, and S/FPD statuses, respectively ( χ2 = 10.10, P = 0.013). The last follow-up revealed that 71 (59.1%), 36 (30.1%), 13 (10.8%) patients in the FDTC group were in the NED, BPD and S/FPD statuses, respectively, while 337 (70.2%), 114 (23.7%), 29 (6.1%) patients in the SDTC group reached the NED, BPD and S/FPD statuses, respectively ( χ2 = 8.99, P = 0.026). The F-NED and S-NED subgroups exhibited 5-year DFS rates of 92.4% and 97.4%, respectively, the F-BPD and S-BPD subgroups displayed 5-year PFS rates of 88.3% and 90.8%, respectively, while the F-S/FPD and S-S/FPD subgroups yielded in 5-year PFS rates of 78.2% and 79.6%, respectively. Univariate binary logistic regression analysis indicated that the maximum diameter of tumors, T stage, M stage, recurrence risk stratification, and postoperative stimulated thyroglobulin (p-sTg) were correlated with the achievement of the NED status ( χ2=6.37-13.10, P < 0.05). Multivariable binary logistic regression analysis showed that T stage and p-sTg were independent risk factors in the achievement of the NED status ( χ2=0.11-11.33, P < 0.05). Conclusions:The response to initial RIT assists in guiding the development of subsequent treatment and follow-up strategies for DTC patients. Given that the SDTC patients exhibited better outcomes than the FDTC patients, more alertness should be paid to the RIT for FDTC patients. For patients with higher p-sTg and T stage, the initial RIT dose and follow-up interval should be increased and reduced respectively as appropriate.

Objective To compare the clinical efficacy and postoperative urinary control between robot-assisted radical prostatectomy(RARP)with posterior-anterior-lateral(PAL)approach and with anterior(conventional)approach using propensity score matching method.Methods Clinical data of 145 patients undergoing RARP in our hospital during Jan.2020 and Jan.2023 were retrospectively analyzed,including 122 patients in the conventional group and 23 in the PAL group.The patients were matched by 2∶1 propensity score matching,including 46 cases in the conventional group and 23 in the PAL group.The perioperative outcomes were compared of prostate cancer(PCa)patients undergoing RARP surgery with different approaches before and after matching,including operation time,intraoperative blood loss,pelvic drainage time,hospitalization days,preservation of neurovascular bundles(NVB)during surgery,deep dorsal venous complex(DVC)suture,reconstruction of bladder neck,and postoperative urinary control recovery rate after extubation immediately,and 1,3,and 6 months after surgery.Results There were no significant differences in baseline data,operation time,bleeding volume,pelvic drainage time,hospitalization days,preservation of NVB,and reconstruction of bladder neck between the two groups(P＞0.05).The PAL group used less DVC suture during surgery(30.4％vs.100％,P＜0.001),but had better urinary control recovery rate immediately after extubation,1,3 and 6 months after surgery(P＜0.05).Conclusion RARP with PAL approach is as safe and effective as the conventional approach,and has significant advantages in early postoperative urinary control.

Objective To explore the application of Plan-Do-Check-Act(PDCA)cycle management to continuously im-prove the service quality of outpatient pharmacy and enhance patient satisfaction.Methods To address the problem of long wait-ing time for patients in outpatient pharmacy,we applied PDCA cycle to investigate the factors affecting patients'waiting time in the process of medicine collection,analyze the current situation,determine the expected goals,formulate the service quality im-provement plan of outpatient pharmacy,implement the improvement plan,follow up and supervise,and summarize and analyse the problems regularly until it was solved.Results After implementing the PDCA cycle in the management,the service quality of outpatient pharmacy was improved,the waiting time was significantly shortened and the satisfaction of medical treatment was in-creased.Conclusion The application of PDCA cycle method is effective in improving the service quality of outpatient pharmacy.Therefore,it is recommended for broader implementation.

AIM:Bone morphogenetic protein 7(BMP7)reduces the expression of Yes-related protein 1(YAP1)by down-regulating Ajuba level and decreasing extracellular matrix(ECM)deposition.This study aimed to inves-tigate the influence of these factors on modifying the degree of renal fibrosis in rats with diabetic nephropathy.METH-ODS:Eighteen Sprague-Dawley(SD)rats were randomly divided into three groups:the normal control(NC)group,the diabetes mellitus(DM)group,and the DM group treated with BMP7 overexpressing adeno-associated virus(DM+rAAV-BMP7).Each group consisted of six rats.Diabetic kidney disease(DKD)was established in the DM and DM+rAAV-BMP7 groups by injecting 55 mg/kg streptozotocin(STZ)via the tail vein.NRK-52E cells were divided into three groups:the normal glucose(NG)group,the high glucose(HG)group,and the high glucose group treated with recombinant hu-man BMP7(HG+rhBMP7)group.Pathological changes in renal tissues were observed using hematoxylin and eosin(HE)and Sirius red staining.Immunohistochemical staining was performed to examine the expression sites of Ajuba and YAP1 in the renal cortex.Western blot analysis was conducted to determine the expression levels of BMP7,Ajuba,YAP1,colla-gen type Ⅲ(Col-Ⅲ),and fibronectin(FN)in the rat renal cortex and NRK-52E cells.RT-qPCR was used to measure the mRNA levels of Ajuba and YAP1 in the rat renal cortex.RESULTS:Biochemical indices revealed significantly ele-vated levels of blood glucose,serum creatinine,triglycerides,total cholesterol,and 24-hour urinary protein in the DM group compared to the NC group(P<0.05).In the DM+rAAV-BMP7 group,the levels of serum creatinine,24-hour uri-nary protein,triglycerides,and total cholesterol were lower than those in the DM group(P<0.05).Pathological staining demonstrated that the renal interstitium of the DM group exhibited inflammatory cell infiltration,fibrous tissue,collagen fi-ber deposition,disordered renal tubule arrangement,atrophy,and vacuolar degeneration,which were ameliorated in the DM+rAAV-BMP7 group.Immunohistochemistry revealed that Ajuba and YAP1 were mainly expressed in the cytoplasm and nucleus,with high expression in the cytoplasm of the DM group,which was significantly decreased in the DM+rAAV-BMP7 group.Western blot results indicated that the protein levels of FN,Col-Ⅲ,Ajuba,and YAP1 were up-regulated in the DM and the HG groups(P<0.05),but significantly down-regulated in the DM+rAAV-BMP7 group(P<0.05).RT-qP-CR results demonstrated that the mRNA levels of Ajuba and YAP1 were higher in the DM group and significantly lower in the DM+rAAV-BMP7 group(P<0.05).CONCLUSION:The overexpression of BMP7 can ameliorate renal fibrosis in rats with DKD.This effect is likely mediated by the down-regulation of Ajuba,reduction of YAP1 expression,and subse-quent inhibition of ECM deposition.

Objective:To explore the role and molecular mechanism of Shikonin(SKN) in inhibiting the growth of anaplastic thyroid carcinoma(ATC) cells.Methods:The effect of SKN on ferroptosis in ATC cell lines CAL-62 was detected by flow cytometry; the expression levels of NF-κB, ferroptosis-related genes glutathione peroxidase 4(GPX4) and selenoprotein thioredoxin reductase 1(TXNRD1), glucose metabolism-related genes pyruvate kinase isoform 2(PKM2) and glucose transporter protein 1(GLUT1) were detected by Western blotting; real-time fluorescence quantitative(qPCR) to detect changes in the expression levels of GPX4, PKM2 and GLUT1; reactive oxygen species(ROS) fluorescent probe to detect changes in intracellular ROS positivity; glucose and lactic acid assay kit to detect the levels of glucose, the raw material of glucose metabolism(GLU), and lactate(LD), the product of glucose metabolism; and establishment of a subcutaneous tumour model in BALB/c nude mice to analyse the inhibitory effect of SKN on ATC in vivo.Results:Compared to the control group, after SKN treatment, the protein expression levels of NF-κB, GPX4, TXNRD1, GLUT1, and PKM2 in CAL-62 cells decreased( P=0.004, P=0.012, P=0.043, P=0.001, P=0.018); the mRNA expression of GPX4, GLUT1, and PKM2 also decreased( P<0.001, P=0.029, P<0.001). Additionally, ROS production increased( P=0.041). After treatment with the ferroptosis inhibitor Liproxstatin-1(L-1), the proportion of cell death was reversed to a certain extent, and there was no statistically significant difference in cell death proportion after L-1 treatment. Intracellular ferroptosis occurred( P<0.001), with reduced levels of glutamate(GLU) uptake and lipid peroxidation(LD) generation( P<0.001). SKN inhibited ATC tumor growth in vivo( P=0.016). Conclusion:SKN promotes intracellular ferroptosis in ATC cells, inhibits glycolysis and glucose uptake, and suppresses ATC cell growth.