BACKGROUND:Endometrial injury is a common benign disease in women of reproductive age,which seriously affects their fertility and reproductive health.In recent years,mesenchymal stem cells and their secreted extracellular vesicles,as a new therapeutic strategy,have received much attention in the repair of endometrial injury.OBJECTIVE:To review the application of mesenchymal stem cells and their secreted extracellular vesicles in the treatment of endometrial injury,to comprehensively understand the therapeutic mechanism and efficacy of endometrial injury,and to discuss the potential and challenges of the application of mesenchymal stem cells and their secreted extracellular vesicles in the treatment of endometrial injury,in order to provide theoretical basis for further basic and clinical research.METHODS:Literature searches were conducted in the China National Knowledge Infrastructure(CNKI),Chinese Medical Full-text Database,and PubMed electronic databases using search terms"mesenchymal stem cells,extracellular vesicles derived from mesenchymal stem cells,exosome,endometrial injury,intrauterine adhesion,Asherman's syndrome"in Chinese and English.Articles were selected through manual screening to exclude duplicates and irrelevant studies,resulting in the inclusion of 87 articles.RESULTS AND CONCLUSION:Mesenchymal stem cells and their secreted extracellular vesicles can participate in endometrial damage repair through a variety of molecular mechanisms,such as anti-fibrosis,promoting angiogenesis and cell proliferation,cell homing,immune regulation,and endometrial receptibility regulation.A large number of research results have been achieved in cell and animal experiments,and preliminary results of clinical studies have also achieved certain curative effects,including increased endometrial thickness,improved menstrual volume and fertility.However,difficulty and challenges persist in the application of mesenchymal stem cells and their secreted extracellular vesicles for endometrial injury treatment.During treatment,it is necessary to enhance the quality and stability of mesenchymal stem cells and their secreted extracellular vesicles,as well as clarifying their roles in processes such as cell proliferation,migration,and differentiation.Moreover,large-scale multicenter clinical trials are needed to validate the long-term safety and efficacy of mesenchymal stem cells and their secreted extracellular vesicles in endometrial repair,and to determine optimal dosages and administration routes.Continuous advancements in scientific technologies and the auxiliary application of bioengineering materials offer hope for developing more effective and safer therapeutic methods for endometrial injury treatment and the above problems will be solved in the future.

BACKGROUND:Endometrial injury is a common benign disease in women of reproductive age,which seriously affects their fertility and reproductive health.In recent years,mesenchymal stem cells and their secreted extracellular vesicles,as a new therapeutic strategy,have received much attention in the repair of endometrial injury.OBJECTIVE:To review the application of mesenchymal stem cells and their secreted extracellular vesicles in the treatment of endometrial injury,to comprehensively understand the therapeutic mechanism and efficacy of endometrial injury,and to discuss the potential and challenges of the application of mesenchymal stem cells and their secreted extracellular vesicles in the treatment of endometrial injury,in order to provide theoretical basis for further basic and clinical research.METHODS:Literature searches were conducted in the China National Knowledge Infrastructure(CNKI),Chinese Medical Full-text Database,and PubMed electronic databases using search terms"mesenchymal stem cells,extracellular vesicles derived from mesenchymal stem cells,exosome,endometrial injury,intrauterine adhesion,Asherman's syndrome"in Chinese and English.Articles were selected through manual screening to exclude duplicates and irrelevant studies,resulting in the inclusion of 87 articles.RESULTS AND CONCLUSION:Mesenchymal stem cells and their secreted extracellular vesicles can participate in endometrial damage repair through a variety of molecular mechanisms,such as anti-fibrosis,promoting angiogenesis and cell proliferation,cell homing,immune regulation,and endometrial receptibility regulation.A large number of research results have been achieved in cell and animal experiments,and preliminary results of clinical studies have also achieved certain curative effects,including increased endometrial thickness,improved menstrual volume and fertility.However,difficulty and challenges persist in the application of mesenchymal stem cells and their secreted extracellular vesicles for endometrial injury treatment.During treatment,it is necessary to enhance the quality and stability of mesenchymal stem cells and their secreted extracellular vesicles,as well as clarifying their roles in processes such as cell proliferation,migration,and differentiation.Moreover,large-scale multicenter clinical trials are needed to validate the long-term safety and efficacy of mesenchymal stem cells and their secreted extracellular vesicles in endometrial repair,and to determine optimal dosages and administration routes.Continuous advancements in scientific technologies and the auxiliary application of bioengineering materials offer hope for developing more effective and safer therapeutic methods for endometrial injury treatment and the above problems will be solved in the future.

Objective To evaluate the effect of peer education on postoperative rehabilitation of patients with laryngeal cancer.Methods From January 2010 to December 2012,240 cases of primary laryngeal cancer were treated with partial or total laryngectomy as well as tracheotomy in the Department of Head and Neck Surgery in Shandong Provincial Hospital.The patients were randomly divided into experimental group or control group by Stochastic tables law,120 patients in control group accepted only conventional nursing,120 patients in experimental group accepted both conventional nursing and peer education.The difference in the treatment nursing cooperation attitude,postoperative recovery,postoperative symptoms and the incidence of complications between two groups were evaluated by postoperative quality of life (UW-QOL),Eysenck personality questionnaire (EPQ) and coping style questionnaire (CSQ) score.The independent sample T-test and x2 test were used for statistical analysis.Results The patients of experimental group showed more positive attitude to treatment and care compared to the patients of control group (x2 =10.7,P ＜0.01).Experimental group had less time in postoperative wound healing time,gastric tube indwelling time and postoperative hospital stay than control group,with statistically significant differences (t =6.89,t =6.36,t =6.42,respectively,P ＜ 0.01) ; Incidence of postoperative discomfort symptoms in experimental group was less than that in control group (P ＜ 0.05).Total score for quality of life (UW-QOL) in experimental group was higher than that in control group (t =2.40,P ＜ 0.05).The P and N scores of EPQ in experimental group were lower than those in control group (t =2.28,t =2.60,P ＜ 0.05),while the E score of EPQ in experimental group was significantly higher than that in control group (t =4.50,P ＜ 0.01),with no significant difference in the L score of EPQ between two groups (P ＞ 0.05).scores of factor to solve problem and help factor of CSQ in experimental group were higher than those in control group (t =7.05,t =7.73,P ＜ 0.01),and the era factor score of experimental group was lower than that of control group(t =2.05,P ＜ 0.05).Conclusions Peer education can help the patients with laryngectomy to maintain good psychological and mental status,to cooperate actively with treatment,to reduce symptoms and complications,and to shorten the length of hospital stay,improving their postoperative rehabilitation and quality of life.

Objective To investigate the effect of methylene blue(MB)on liver ischemia-reperfusion (I/R) injury in rabbits.Methods Twenty-four healthy New Zealand white rabbits of both sexes welshins 2.0-2.3 kg were randomly divided into 3 groups (n=8 each):group Ⅰ sham operation(group s);group Ⅱ I/R and group Ⅲ methylene blue (group MB).The animals were anesthetized with intravenous 2% pentobarbital 30 mg/kg.Liver I/R was produced by occlusion of hepatic blood flow for 40 min followed by 60 min repeffusion.In group MB methylene blue 5 mg/kg was injected iv at 20 min before liver ischemia.Femoral artery was carmulated for MAP monitoring and blood sampling.MAP and HR were recorded immediately before(T1,baseline)and at 20 and 40 min of ischemia (T2,3) and 1,5,30,60 min(T4-7)of repedusion.Blood samples were collected at T1,T5,T6 and T7 for measurement of seruln TNF-α and IL-6 concentrations.Plasma AST and ALT activities were measured at T1,T6 and T7.Liver specimens were obtained at the end of experiment for determination of SOD activity and MDA content.Results In group I/R MAP was significantly decreased at T4-7 during reperfusion and HR at T7 as compared with the baseline at T1;while in group MB no significant change in MAP and HR Was observed during ischemia and reperfusion as compared with the baseline.The gerum TNF-α and IL-6 concentrations and the plasma ALT and AST activities were significantly increased during reperfusion as compared with the baseline immediately before ischemia in group I/R and MB and were significantly lower in group MB than in group. I/R. The SOD activity was significantly higher while MDA content was significantly lower in group MB than in group I/R. Microscopic examination showed that liver damage was less severe in group MB than in group I/R. Conclusion The administration of MB can maintain hemodynamic stability and attenuate liver I/R injury in rabbits.

Objective To investigate the role of Notch signaling pathway in cerebral ischemic tolenmce induced by clectroacupuncture (EA) preconditioning.Methods Fifty-two adult male SD rats weighing 280-320 g were randomly divided into 2 groups(n=each):control group(group C)and electroacupuncture preconditionig group(group EA).Group C received no treatment.Group EA received EA at the Baihui acupoint (GV20) for 30 min a day for 5 days.Twenty-four hours after the last preconditionig,focal cerebral ischemia was induced by middle cerebral artery occlusion (MCAO) for 120 min,followed by 72 h of reperfusion.Notch intracellular domain(NICD)expression was determined by Western blot and expression of Notch1,Notch4,Jag1,and Hes1 mRNA by real-time PCR immediately before iachemia and 24 and 72 h of reperfusion.The neurological deficit was scored at 72 h of reperfusion.The infarct volumes were then determined after evaluation of the neurological deficit score .Results There was no significant difference in Hesl mRNA and NICD expression immediately before ischemia between group EA and C(P>O.05).NICD expression was up-regulated at 24 and 72 h of reperfusion in both groups, and Hesl mRNA expression at 72 h of reperfusion in group C and at 24 h of reperfusion in group EA was up-regulated compared with those immediately before ischemia (P < 0.05). Hes1 mRNA and NICD expression was up-regulated in group C, while down-regulated in group EA at 72 h of reperfusion compared with those at 24 h of reperfusion ( P < 0.05 ). Compared with group C, the expression of Notchl,Notch4 and Jag1 mRNA was up-regulated immediately before ischemia, and Hes1 mRNA and NICD expression was up-regulated at 24 h of reperfusion while down-regulated at 72 h of reperfusion in group EA( P < 0.05). EA preconditioning significantly reduced infarct volumes and increased neurological deficit scores at 72 h of reperfusion (P < 0.05 ). Conclusion Notch signaling pathway may participate in cerebral ischemic tolerance induced by EA preconditioning.

Objective To investigate the effect of different programs of preconditioning with hyperbaric oxygen (HBO) on spinal cord ischemia-reperfusion injury (I/R) in rabbits. Methods Forty-five New Zealand rabbits aged 4-5 months weighing 2.0-2.5 kg were randomly divided into 5 groups: group S, sham operation ( n = 5);group IR, spinal cord I/R injury (n = 10);group H_(1～3) , the animals were pretreated with 100% O_2 at 2.5 ATA 1 h/d for 5 (group H_1 ), 10 (group H_2 ) , or 20 (group H_3 ) consecutive days respectively 24 h before spinal cord I/R. The animals were anesthetized with iv pentobarbital sodium 30 mg/kg. The artery in the ear and left femoral artery were cannulated for proximal and distal mean blood pressure monitoring. Spinal cord ischemia was produced by cross-clamping of abdominal aorta distal to renal artery for 20 min. Hind-limb motor function was assessed at 48 h after reperfusion according to the modified criteria established by Tarlov (0 = no spontaneous movement, 4= normal motor function) . The animals were then killed and the L_5 segment of the spinal cord was removed for detection of neuronal survival (by HE staining), apoptosis (by TUNEL) and degeneration (by Fluoro-Jade B staining). Results Preconditioning with 5 or 10 d of HBO improved the hind-limb motor function and preserved more normal neurons in the spinal cord after I/R injury. Both apoptotic and degenerative cell death were attenuated in H_1 and H_2 groups. There was no significant difference in hind-limb motor dysfunction and the number of normal neurons in the lumbar spinal cord between H_3 group and I/R group. Conclusion Preconditioning with 5 d or 10 d HBO induces tolerance against spinal cord I/R injury, whereas preconditioning with 20 d of HBO fails to protect the spinal cord from I/R injury.

The standardized training for residents is the key point of medical education and clinical level enhancement.The future clinicians not only must have the solid specialized knowledge,but also should have the rich humanities and the social sciences knowledge,good interpersonal communication ability,as well as lofty occupational ethics.Therefore,how to train residents to be rich in both the spirit of science and humanity and the knowledge of science and humanity,has become an important topic in the clinical medicine education.

OBJECTIVETo investigate whether pretreatment with repeated electroacupuncture (EA) at the Baihui acupoint could induce ischemic tolerance against transient focal cerebral ischemic injury in rats.

METHODSThirty male Sprague-Dawley (SD) rats were randomly divided into 3 groups (n=10 for each): the control group consisted of animals receiving no treatment, the isoflurane (ISO) group had animals that inhaled 1.5% isoflurane for 30 min a day for 5 days, and animals in the EA group received electroacupuncture at the Baihui acupoint for 30 min a day for 5 days under 1.5% isoflurane anesthesia. Twenty-four hours after the last treatment, the middle cerebral artery was occluded with No. 3 nylon monofilament for 120 min. The neurological outcomes were evaluated 24 h after reperfusion. The infarct volumes were then assessed using 2% triphenyltetrazolium chloride staining after the neurological outcome evaluation.

RESULTSThe neurological deficit score (NDS) of the EA group [1 (0-2)] was lower than that of the ISO group [2 (1-3)] and the control group [2 (1-4)], P < 0.05. The infarct volume of the EA group (38.3 +/- 25.4 mm(3)) was significantly smaller than that of the control group (220.5 +/- 66.0 mm(3)) and the ISO group (168.6 +/- 57.6 mm(3)) 24 h after reperfusion.

CONCLUSIONElectroacupuncture at the Baihui acupoint 30 min a day for 5 days significantly reduces neurological injury induced by transient middle cerebral artery occlusion.

Objective To analyze the effect of total parenteral nutrition (TPN) and enteral nutrition (EN) in patients with acute pancreatitis. Methods Randomized controlled trials of TPN and EN in patients with acute pancreatitis were searched in Medline and China Biological Medicine Disk from Jan 1966 to June 2004. Eight studies were enrolled into the analysis. The detail about the trial design, characters of the subjects, results of the studies were reviewed by two independent authors and analysed by using Revman 4.2 software. Results Compared with TPN, EN was associated with a significantly lower incidence of secondary infections (RR 0.45, 95% CI 0.29-0.68, P=0.0002) and other complications(RR 0.67, 95% CI 0.47-0.96, P=0.03), fewer surgical interventions (RR 0.47, 95%CI 0.24-0.94, P=0.03) and shorter hospitalization. However, there was no significant difference in mortality (RR 0.61, 95%CI 0.32-1.18, P=0.14) between patients with TPN and EN. Conclusion EN could be the preferred nutrition feeding method in patients with acute pancreatitis.

Objective To investigate the dose response effects of Shenfu injection, an intravenous drug made from traditional Chinese herbs, on the ischemic spinal cord injury in rabbits Methods New Zealand white rabbits were anesthetized with halothane and spinal cord ischemia was induced with 20 min infrarenal aortic occlusion Animals were randomly allocated to 4 groups, in group A(n=6) without pharmacologic intervention, in group B (n=6) ,group C (n=6) and group D (n=6) Shenfu injection 5,10 and 20ml?kg -1 were infused intravenously at a constant rate within 30min before the aortic cross clamping, respectively Neurologic status was scored by the Tarlov system 1,4,8,12,24 and 48h following reperfusion The animals were sacrificed 48h following reperfusion to sample the spinal cord (L5 7) immediately for histopathologic study Results All animals survived during the experiment Compared with that in group A, the neurologic deficit score (NDS) increased significantly at each observing time in group B, group C and group D (P0 05), but there was no significant difference between group B, C and D NDS in group A,B,C and D 48h after reperfusion were 0 5?0 8,3 2?0 9(P