OBJECTIVE To investigate the effects of renally inappropriate medication （RIM） on the frailty of elderly patients with diabetes. METHODS The data of elderly patients with diabetes mellitus admitted to a third-grade class A hospital in Yunnan province from January to December 2022 were collected， and Beers criteria （2019 edition） and Chinese version of FRAIL scale were used to evaluate RIM and the frailty of the patients； the patients were divided into the trial group （with RIM） and the control group （without RIM） according to whether there was RIM. The propensity score matching was used to balance confounding factors between two groups， and the influence of RIM on the frailty of elderly diabetic patients was analyzed by the Logistic regression model. RESULTS Among the 367 patients， 80 patients （21.80%） had RIM， the drugs involved RIM were spironolactone （82.56%）， rivaroxaban （13.95%） and gabapentin （3.49%）. After reaching the balance between groups using the propensity score matching method， the incidence of frailty was 77.94% in trial group and 27.94% in control group （P＜0.001）； the difference was not statistically significant in other confounding factors between the two groups （P＞0.05）. Results of Logistic regression analysis showed that the risk of frailty in the experimental group was 3.118 times that of the control group （odds ratio was 3.118，95% confidence interval was 1.758-5.530， P＜0.001）. CONCLUSIONS RIM is a risk factor for the frailty of elderly patients with diabetes， which can be considered as an indicator for early identification and screening of the frailty of elderly diabetes patients.

Objective To analyze the relationship between the common clinical indicators and diabetic foot ulcer(DFU)in type 2 diabetes mellitus(T2DM)patients by using the cross-sectional study and to provide the reference indicators for clinical DFU monitoring and prognosis evaluation.Methods A total of 115 T2DM patients admitted to the Department of Endocrinology,the Second Affiliated Hospital of Kunming Medical University from June 2021 to June 2023 were selected as the study objects and were divided into group A(with DFU)and group B(without DFU)according to whether they had DFU.Those in group A were then divided into group A1(Wagner0-1),group A2(Wagner2-3)and group A3(Wagner4)according to Wagner classification.The differences of general data,blood pressure,blood glucose,blood lipids and other common clinical indicators among all of the groups were compared,and the correlation between DFU and the above indicators was explored.Results Diabetes duration,D-dimer(DD),systolic blood pressure and other indexes in group A were higher than those in group B and there was a statistically significant difference(P<0.05).DD was the main risk factor for DFU in T2DM patients.Diabetic course in patients with DFU was positively correlated with the age(r>0,P<0.05),and negatively correlated with fasting blood glucose(FPG)level and 2hPG level at 2 hours after meals(r<0,P<0.05).The levels of interleukin-6(IL-6)and C-reactive protein(CRP)in A1 and A2 groups were lower than those in A3 group,the levels of neutrophils and leukocytes in A1 group were lower than those in A3 group,and the high density lipoprotein cholesterol(HDL-C)in A1 group was higher than that in A2 group and there was a statistically significant difference(P<0.05).Conclusion DD and systolic blood pressure are the main risk factors for DFU,and DD is closely related to DFU.The older the patients with T2DM,the later the onset of DFU.The worse the blood glucose control,the earlier the onset of DFU.HDL-C is a protective factor for peripheral vascular disease in T2DM patients.

Diabetic foot(DF)is one of the most severe chronic complications of diabetes mellitus(DM),and it is an important cause of disability and mortality inpatients with DM.Changes in proteins in the tissues,organs and circulation of organisms can serve as microscopic reflections of the disease development process.Proteomics is an important technologyto explore the pathogenesis and treatment mechanism of dis-ease,and to find potential therapeutic targets and prognostic biomarkers of diseases.This article reviews the progress of proteomics research in DF.

BACKGROUND:Exosomes play a role in all stages of wound repair,and there is currently a large body of research on exosomes in skin wound repair,which has been shown to have great potential for clinical applications. OBJECTIVE:To summarize and discuss the main mechanisms and clinical applications of exosomes in the treatment of skin wounds,in order to promote the clinical translation of exosomes. METHODS:PubMed,clinicaltrials.gov,China National Knowledge Infrastructure,Food and Drug Administration database,and Chinese Clinical Trial Register were searched from inception to March 2023.The English search terms were"exosomes,wound healing,stem cells,chronic wound,immunoregulation,inflammation,skin,therapeutic use,isolation,characterization,infections".The Chinese search terms were"exosomes,wound healing,stem cells,immunomodulation,clinical applications".A total of 79 articles were included for the summary. RESULTS AND CONCLUSION:(1)Exosomes can improve and accelerate wound healing through inflammation regulation,immune protection,angiogenesis,cell proliferation and migration,and collagen remodeling.(2)Exosomes derived from stem cells have mature preparation techniques and related mechanism research,which is currently the mainstream research direction.Non-stem cell-derived exosomes have the advantages of convenience,economy,and easy production,and can be used as a supplement for clinical applications.(3)The clinical application of exosomes is still in its infancy,but has great potential for application.Various exosome modification techniques have laid the foundation for the future development of clinically personalized services and require further research.(4)The clinical translation of exosomes faces many challenges,such as low yield,high heterogeneity,lack of unified standards for isolation,purification,and quality control,and difficulties in storage.

OBJECTIVE To explore the therapeutic effect and safety of Maiwei Yangfei Decoction(MWYF)in the treatment of idiopathic pulmonary fibrosis of qi-yin deficiency type.METHODS A total of 58 patients with idiopathic pulmonary fibrosis of qi-yin deficiency type were randomly divided into an experimental group and a control group with 29 cases in each group according to a 1:1 ratio.Two cases dropped out of the experimental group and three cases dropped out of the control group.The control group received standardized treatment of Western medicine,and the experimental group received MWYF on the basis of the treatment of the control group.The treatment course of both groups was 3 months.The TCM syndrome score,lung function,6-minute walking distance(6MWD),transcutaneous blood oxygen saturation(SpO2),high-resolution computed tomography(HRCT)score,St.George's respir-atory questionnaire(SGRQ)score and serum sialoglycoprotein antigen(KL-6)level of the two groups were compared before and after treatment.Blood routine and liver and kidney function of the two groups were detected before and after treatment,and the occurrence of adverse reactions during treatment was recorded.RESULTS After treatment,the total score of TCM syndrome of the two groups was significantly improved(P<0.01),and the experimental group was better than the control group(P<0.01);the DLCO%of the experi-mental group increased(P<0.05),and the experimental group was higher than the control group(P<0.05).The experimental group showed significant improvement in 6MWD,HRCT grid shadow,SGRQ symptom score and total score,and serum KL-6 level(P<0.05,P<0.01),which was better than the control group(P<0.05,P<0.01).No serious adverse events occurred in either group dur-ing the treatment.CONCLUSION MWYF combined with standardized Western medicine treatment can effectively improve the clini-cal symptoms of patients with idiopathic pulmonary fibrosis of qi-yin deficiency type,reduce the expression level of serum KL-6,and has a definite effect and good safety.

Objective: To investigate the willingness to accept preventive treatments and its related factors among college freshmen with latent tuberculosis infection (LTBI), so as to provide the evidence for preventive treatment intervention measures for students with LTBI. Methods: Cluster sampling method was used to select 368 LTBI freshmen from 8 colleges and universities in Changzhou in September 2023, who conducted a questionnaire survey on the willingness to receive preventive treatment. General demographic data were collected and relevant data were collected using tuberculosis knowledge scale, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Adaptation, Partnership, Growth, Affection and Resolve (APGAR), and a self developed Stigma Scale. A binary Logistic regression model was constructed with the willingness to accept preventive treatment as the dependent variable to analyze the willingness to accept preventive treatment and the influencing factors. Results: A total of 253 LTBI college freshmen were willing to take preventive treatment, the acceptance rate was 68.75%. The rate of willingness to accept preventive treatment for LTBI was higher among students whose fathers had an education level of high school, compared to those whose fathers had an education level of junior high school or below ( OR =2.16, P <0.05). LTBI students whose per capita family income was >5 000-10 000 yuan and >10 000 yuan were more willing to accept LTBI preventive treatment than those whose per capita family income was <3 000 yuan ( OR =2.72, 4.46, P <0.05). LTBI students who engaged in physical exercise for more than 2 hours per week were more willing to accept than those who exercised less than 0.5 hours per week ( OR =1.91, P <0.05). LTBI students with high levels of tuberculosis knowledge and stigma were more likely to receive preventive treatment ( OR =1.18, 1.11, P < 0.05). LTBI students with high PHQ-9 ( OR =0.85) and GAD-7 ( OR =0.92) scores were more likely to refuse preventive treatment ( P <0.05). Conclusion The present study revealed a moderate level of willingness of LTBI students to preventive treatment in Changzhou City, and the acceptance is affected by family factors, healthy lifestyles, tuberculosis knowledge and psychological status.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

Background: and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities. Methods: This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups. Results: Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]). Conclusion In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.

Objective:To evaluate the diagnostic value of multiparametric cardiac magnetic resonance(CMR)or detecting the occurrence of acute rejection(AR)after heart transplantation(HT).Methods:From 2019 to 2021, 44 HT recipients are prospectively recruited from Guangdong Provincial People's Hospital.Another 51 healthy volunteers are recruited from a local community as healthy controls.CMR studies are performed for obtaining baseline parameters.According to the clinicopathological diagnostic criteria of AR by the consensus of International Society for Heart and Lung Transplantation, 81 CMR studies of 44 HT recipients are further divided into two groups of AR (18 cases)and non-AR(71 cases). CMR parameters includ global ventricular structure/function, T2, T1, extracellular volume(ECV)and late gadolinium enhancement(LGE). A combined model is established by binary Logistic regression and receiver operator characteristic curve(ROC)constructed.Results:The age range is(41.8±16.8)years in 44 HT recipients and(41.8±9.7)years in 51 healthy controls.T1 mapping indicated that myocardial global ECV of left ventricle is significantly higher in AR patients than non-AR controls(32.4%±6.0% vs 28.5%±2.4%; P<0.001 9). Global native T1 is higher in AR group than that in non-AR group(49.8±3.1 vs 47.5±2.8 ms, P=0.009)and the difference is statistically significant.The cutoff value of global ECV is 30.62% with a sensitivity of 61% and a specificity of 86% for detecting AR.And T2 mapping reveale that T2 value of global left ventricle is significantly higher in AR group than that in non-AR group(49.8±3.1 vs 47.5±2.8 ms, P=0.009). LGE extent is significantly higher in AR group than those in non-AR group( P=0.004). Through including global native T1 and ECV into a logistic regression model, multiparametric CMR can yield an area under curve(AUC)of 0.794.It hints at the potential of CMR for detecting AR. Conclusions:Multiparametric cardiac magnetic resonance offers an excellent predictive capacity for a noninvasive detection of AR.

Objective:To systematically review the qualitative research on dignity cognition and experience of the elderly in nursing homes.Methods:Qualitative research on the dignity cognition and experience of the elderly in nursing homes was retrieved by computer in PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, China National Knowledge Infrastructure, Wanfang Data, VIP and China Biology Medicine disc. The retrieval time limit was from the establishment of the database to May 31, 2021. The quality of the article was assessed using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center.Results:A total of 10 articles were included, and 30 research results were extracted. The research results were grouped into 8 categories, and 4 integrated results were synthesized, namely, the elderly's cognition of dignity, the impact of impaired dignity on the elderly, the factors affecting the maintenance of dignity, and the elderly's dignity maintenance strategies.Conclusions:Nursing homes should attach importance to the dignity of the elderly, provide dignity care, protect the autonomy of the elderly, and strengthen the social support system to promote the realization of the elderly with dignity.