Exosomes, as crucial mediators of intercellular communication, exhibit a wide range of biological functions in the onset and treatment of atherosclerosis (AS). Recent studies have indicated that exosomes can carry various active substances, including miRNA, lncRNA, proteins, and lipids. By regulating inflammatory responses, lipid metabolism, vascular endothelial function, and the immune microenvironment, they mediate the formation, progression, and reversal of AS at multiple levels. Specifically, miRNAs within exosomes can target and regulate the expression of inflammatory factors, inhibiting macrophage activation and foam cell formation. Meanwhile, exosomes derived from endothelial cells (EC) or stem cells can enhance vascular endothelial integrity and suppress endothelial dysfunction (ED). Furthermore, exosomes have been extensively explored as natural carriers for delivering drugs and nucleic acid molecules. Their membrane structure possesses excellent biocompatibility and targeting capabilities, showcasing significant potential as a novel therapeutic tool. Starting from basic mechanistic studies, this article summarizes the molecular pathways and key biological effects of exosomes in AS intervention, and further explores their current clinical application and multiple challenges they face, aiming to provide theoretical support and research directions for novel cardiovascular disease intervention strategies.

Background and purpose:The microphthalmia-associated transcription factor(MITF)plays a complex role in melanoma pathogenesis and progression.It is known to regulate multiple processes both in melanocytes and melanoma cells.While numerous studies have explored MITF in cutaneous melanoma(CM),research in acral melanoma(AM)is still limited.This study retrospectively analyzed the correlation between MITF expression and clinical,pathological characteristics and prognosis in AM patients,providing a basis for prognosis evaluation and personalized treatment plan formulation for patients.Methods:Patients who underwent primary resection of AM at Fudan University Shanghai Cancer Center from March 2008 to February 2022 were included.All surgical samples were diagnosed by clinical histopathology and used to construct the tissue microarray(TMA).This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(approval number:2203-ZZK-69-3).Cutting complete tissue microarray and evaluating MITF expression levels by immunohistochemistry(IHC)staining were carried out.The results were independently assessed and scored by three pathologists.Clinical and pathological data were collected from the hospital's electronic medical record system,and each patient's data was matched to their corresponding tissue sample on the chip.Patients were stratified into two groups based on MITF expression levels.Statistical analyses were performed to assess differences in clinical,pathological characteristics and survival outcomes between these two groups.Results:A total of 137 AM patients were included.MITF expression was significantly associated with T stage,N stage,American Joint Committee on Cancer(AJCC)stage,clark level,sentinel lymph node status,and presence of ulceration.Among these,N stage and ulceration were independent risk factors for high expression of MITF after adjusting for confounding factors.Survival analysis showed that AM patients with high MITF expression or higher T stage were associated with shorter disease-free survival(DFS).Patients with high MITF expression showed no significant difference in overall survival(OS)between observation or cytokine therapy and adjuvant immune checkpoint inhibitor(ICI)therapy,whereas those with low MITF expression derived significant survival benefits from ICI treatment.Conclusion:A higher N stage or the presence of ulceration indicates high MITF expression in tumor cells,with high MITF levels serving as a warning signal for early recurrence,metastasis,and even death.Patients with low MITF expression could receive improved OS with early adjuvant ICI therapy.MITF could not only serve as an auxiliary diagnostic marker for melanoma but also provide a basis for clinical prognosis assessment and the formulation of personalized treatment plans.

Background and purpose:The microphthalmia-associated transcription factor(MITF)plays a complex role in melanoma pathogenesis and progression.It is known to regulate multiple processes both in melanocytes and melanoma cells.While numerous studies have explored MITF in cutaneous melanoma(CM),research in acral melanoma(AM)is still limited.This study retrospectively analyzed the correlation between MITF expression and clinical,pathological characteristics and prognosis in AM patients,providing a basis for prognosis evaluation and personalized treatment plan formulation for patients.Methods:Patients who underwent primary resection of AM at Fudan University Shanghai Cancer Center from March 2008 to February 2022 were included.All surgical samples were diagnosed by clinical histopathology and used to construct the tissue microarray(TMA).This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(approval number:2203-ZZK-69-3).Cutting complete tissue microarray and evaluating MITF expression levels by immunohistochemistry(IHC)staining were carried out.The results were independently assessed and scored by three pathologists.Clinical and pathological data were collected from the hospital's electronic medical record system,and each patient's data was matched to their corresponding tissue sample on the chip.Patients were stratified into two groups based on MITF expression levels.Statistical analyses were performed to assess differences in clinical,pathological characteristics and survival outcomes between these two groups.Results:A total of 137 AM patients were included.MITF expression was significantly associated with T stage,N stage,American Joint Committee on Cancer(AJCC)stage,clark level,sentinel lymph node status,and presence of ulceration.Among these,N stage and ulceration were independent risk factors for high expression of MITF after adjusting for confounding factors.Survival analysis showed that AM patients with high MITF expression or higher T stage were associated with shorter disease-free survival(DFS).Patients with high MITF expression showed no significant difference in overall survival(OS)between observation or cytokine therapy and adjuvant immune checkpoint inhibitor(ICI)therapy,whereas those with low MITF expression derived significant survival benefits from ICI treatment.Conclusion:A higher N stage or the presence of ulceration indicates high MITF expression in tumor cells,with high MITF levels serving as a warning signal for early recurrence,metastasis,and even death.Patients with low MITF expression could receive improved OS with early adjuvant ICI therapy.MITF could not only serve as an auxiliary diagnostic marker for melanoma but also provide a basis for clinical prognosis assessment and the formulation of personalized treatment plans.

Objective:To investigate the relationship between the changes of default network topology properties of brain function and cognitive function in patients with end-stage renal disease (ESRD).Methods:A total of 31 patients with ESRD were enrolled in the Department of Nephrology, Changzhou Second Hospital Affiliated to Nanjing Medical University from January 2019 to December 2020, and 18 healthy persons were included in the same period as the control group.The cognitive function was evaluated with the Montreal cognitive assessment (MoCA) and trail making tests, and then the subjects were examined by resting-state functional magnetic resonance imaging (rs-fMRI). After preprocessing, the brain functional network was constructed and the topology properities of the network were calculated.The SPSS 20.0 software was used for statistical analysis.Independent sample t-test, chi square test and Pearson correlation analysis were used for data statistics. Results:(1) The score of MoCA in the ESRD group(23.37±1.77) was significantly lower than that in the healthy control group(27.94±1.13)( t=9.537, P<0.001). (2) The levels of Eglobal, Elocal, Cp and Sigma in ESRD group ((0.129±0.025), (0.148±0.040), (0.188±0.046), (1.593±0.650)) were significantly lower than those in healthy control group ((0.160±0.040), (0.212±0.024), (0.276±0.049), (2.004±0.864))( t=3.591, 7.474, 7.058, 2.034, all P<0.05). The Lp value of the ESRD group (8.131±1.905) was significantly higher than that of the control group (6.777±2.150)( t=2.583, P< 0.05). The node efficiency values of bilateral dorsolateral superior frontal gyrus, left middle frontal gyrus, bilateral posterior cingulate gyrus, right hippocampus, left superior marginal gyrus, bilateral angular gyrus and bilateral cuneate anterior lobe in ESRD group ((0.133±0.071), (0.201±0.047), (0.211±0.106), (0.175±0.066), (0.276±0.113), (0.122±0.146), (0.042±0.075), (0.171±0.027), (0.154±0.078), (0.240±0.095), (0.161±0.056))were lower than those in the healthy control group((0.312±0.075), (0.289±0.091), (0.277±0.132), (0.284±0.053), (0.368±0.063), (0.231±0.227), (0.120±0.162), (0.296±0.064), (0.310±0.186), (0.318±0.066), (0.286±0.103))( t=2.107-9.436, all P<0.05). (3)Pearson correlation analysis showed that the node efficiency values of bilateral posterior cingulate gyrus and right hippocampus in ESRD group were positively correlated with the score of MoCA( r=0.36, 0.49, 0.53, all P<0.05). Conclusion:The topological structure of brain functional network is abnormal in ESRD patients, which can affect the cognitive function of patients.

The malignant degree of cholangiocarcinoma is high, and the early diagnosis is difficult. The vast majority of patients are unresectable when they are diagnosed. The patients have low quality of life and short survival cycle. Traditional radiotherapy and chemotherapy have poor efficacy and lead to side effects, and thus lack effective control measures for cholangiocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) is an important method for diagnosing and treating biliary tract diseases. Photodynamic therapy (PDT) is a new local treatment for cholangiocarcinoma. In recent years, ERCP-mediated PDT treatment of cholangiocarcinoma has gradually emerged. ERCP-mediated PDT can effectively relieve the symptoms of patients with cholangiocarcinoma, improve the patients' quality of life, prolong the survival cycle, and is expected to become a new treatment for cholangiocarcinoma.
Bile Duct Neoplasms ; diagnosis ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; diagnosis ; Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Photochemotherapy ; Quality of Life

OBJECTIVETo investigate the relationship between occupational stress and mental health in offshore oil platform workers and to provide a scientific basis for protection of their mental health.

METHODSA total of 768 workers on offshore oil platform were surveyed with the Occupational Stress Inventory Revised Edition and Symptom Check List-90 (SCL-90).

RESULTSThe total score of Occupational Role Questionnaire (ORQ) for the workers (160.27±24.63) was significantly lower than the national norm (166.52±27.01) (P < 0.01); the total score of Personal Strain Questionnaire (PSQ) (101.96±19.8) was significantly higher than the national norm (92.45±17.33) (P < 0.01). The total score of Personal Resource Questionnaire (PRQ) for the workers was not significantly different from the national norm (P > 0.05), but the items of recreation, social support, and rational/cognitive found significant difference (P < 0.05). The total score of SCL-90 was positively correlated with all items of ORQ and PSQ (P < 0.01) and negatively correlated with all items of PRQ (P < 0.01). The multiple stepwise regression analysis showed that current work seniority, education background, drinking, role overload, role insufficiency, role ambiguity, responsibility, physical environment, and rational/cognitive conduct impacted the score of SCL-90 (P < 0.05).

CONCLUSIONThe mental health of workers on offshore oil platform is related to occupational stress, and role overload, role ambiguity, physical environment, and rational/cognitive conduct, etc, are closely associated with the workers' mental health.

Adult ; Burnout, Professional ; psychology ; Humans ; Male ; Mental Health ; Middle Aged ; Multivariate Analysis ; Occupational Diseases ; psychology ; Sampling Studies ; Stress, Psychological ; Surveys and Questionnaires ; Workload ; psychology ; Young Adult

Objective To explore the appropriat.e treatment process for elderly patients with intertrochanteric fracture in primary hospitals.Methods According with the evaluation system and the characteristics of the grassroots hospitals and elderly patients with intertrochanteric fractures,the treatment standards for risk assessment was established,and the appropriate treatment process for intertrochanteric fracture in elderly patients in primary hospitals was initially formed and tried to promote applications in three primary hospital from December 2010 to January 2012,and its feasibility and effectiveness were tested.Results 66 elderly patients with intertrochanteric fracture were treated in three primary hospital,and 38 cases were hospitalized in primary hospital,including 24 cases of osseous union in 27cases treated with expectant treatment,11 cases of surgical treatment,and the cure rate was 89.5％.Sent on the operation rate of 90.3％ cases,54.8％ of cases occurred within 2 days.The incident of complications in early stage was 25.8％.Conclusion The diagnosis and treatment process and assessment criteria of treatment risk for elderly patients with intertrochanteric fracture in the primary hospital which is initial established is simple,practical,practicable,and has good effect and certain clinical value.

Objective To explore the clinical effect of lubar intervertebral disc protrusion treatment with ozone injection combined radiofrequency thermocoagulation. Methods 36 patients with lubar intervertebral disc protrusion confirmed by clinical and imaging examination were underwent radiofrequency thermocoagulation followed ozone injection guided with CT. Results All the patients were followed up for 3 ～6 months,and statistic the improvement rate was evaluated according to Macnab standard. The total effective rate was 94.4%, and the improvement rate was 86.1%. Conclusion CT guided treatment could greatly elevate the accuracy of puncture. Radiofrequency target point thermocoagulation combined with ozone injection was a minimally invasive、safet and markedly effective method for lubar intervertebral disc protrusion treatment.

Objective To study the clinical effect of percutaneous laser disc decompression(PLDD) combined with ozone injection in the treatment of cervical spondylosis.Methods 183 cases of cervical spondylosis were randomly divided into two groups.One group of 80 cases with 118 cervical discs herniation were treated with PLDDonly.while the other group of 103 cases with 142 cervical discs herniation were treated with PLDD combined with ozone injectlon.The patients were followed up for 3 to18 months(mean 7 months).The clinical effects were assessed according to the Japanese Orthopaedic Association scoring system(JOA score)and the improvement rates of the two groups were compared.Results 167 cases were followed up.The average point of the group treated with PLDD is 15.2 and the improvement rate is 74.7%.The average point of the group treated with PLDD combined with ozone injection is 16.3 and the improvement rate is 91.3%.The difference between two groups has statistical significance(P＜0.05).Conclusion The treatment of cervical spondylosis with PLDD combined with ozone injection is safe.painless and minimally invasive.The clinical effect is impmved tremendously and much better than monotherapy.