Diabetic peripheral neuropathy (DPN) is one of the chronic complications of diabetic neuropathy, and also the main cause of chronic wounds and disability. Exosomes and exosomal-microRNAs (miRNAs) are closely related to DPN and participate in the signal transduction and protein expression of the peripheral nervous system by mediating intercellular communication. However, the specific role and mechanism of EVs and exosomal-miRNAs in the occurrence and development of DPN in high-glucose environments are not fully understood. This article reviews the promotion of EVs and exosomal-miRNAs in the occurrence and development of DPN in inhibiting axon growth, promoting inflammatory response, and inducing vascular injury in a high glucose environment.

Objective To explore the differential microbiota in patients with newly diagnosed type 2 diabetes mellitus(T2DM),and to preliminarily evaluate the importance of the differential core microbiota in the metabolic disorder.Methods A total of 30 T2DM patients who were treated at the Endocrinology Department of our hospital from September to November 2020,and 30 healthy individuals taking physical examination during the same period were enrolled and assigned into the T2DM group and the control group,respectively.Their blood and fecal samples were collected for the detection of glucose,insulin,and lipid indicators levels and for gut microbiota using 16SrRNA,respectively.Subsequently,bioinformatics analysis,Pearson correlation analysis,and other statistical methods were applied to analyze the differences in T2DM blood indicators and specific bacterial species between the 2 groups.RT-qPCR was used to verify the screening results of small RNA profiles.Then a multi-parameter receiver operating characteristic(ROC)curve model was constructed based on the results of correlation analysis including microbiome,lipid metabolome and miRNAs spectrum genomic detection data of early research.Results T2DM showed specific characteristics of intestinal microbiota,with Phascolarctobacterium and Phascolarctobacterium.faecium(P.faecium)showing significant differences before and after the onset of the disease.Pearson correlation analysis suggested that P.faecium was negatively correlated with high-density lipoprotein(HDL)(r=-0.78,P＜0.001),low-density lipoprotein(LDL)(r=-0.89,P＜0.001),and insulin(r=-0.71,P＜0.001).While,Phascolarctobacterium was negatively correlated with insulin(r=-0.67,P＜0.001)and body mass index(BMI)(r=-0.64,P＜0.001).The ROC curve model based on Phascolarctobacterium/P.faecium,α-linolenic acid,and miR-122-5p could accurately distinguish between T2DM patients and healthy individuals,with a value of area under the curve of 0.928(P=0.0001)and 0.934(P＜0.0001),which suggesting core values of 2 types of bacteria in the disease.Conclusion T2DM patients have specific gut microbiota distribution,in which Phascolarctobacterium and P.faecium are closely associated with metabolic disorders of the disease.The 2 types of bacteria can be regarded as core bacteria for T2DM.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Objective: To investigate the role of fibroblast growth factor receptor(FGFR) 1 in endothelial to-mesenchymal transition(EndMT) and epithelial-to-mesenchymal transition(EMT), and to find out a new strategy to study the vascular endothelial function of diabetic renal fibrosis. Methods: Culture media from FRS2 knockdown HMVECs was transferred to HK-2 cells. Western blot and immunofluorescence staining were used to measure EMT markers and key moleculars of transforming growth factor(TGFβ). Results: It was found that the medium from FRS2 siRNA-transfected HMVECs reduced E-cadherin protein levels, increased EMT markers levels, and activated TGFβ signal pathway in HK-2 cells. Conclusion Endothelial FGFR1 deficiency-induced EndMT leads to EMT in neighboring cells in a manner dependent on TGFβ1 signaling. Endothelial cell FGFR1 is an important molecule for maintaining endothelial homeostasis and epithelial homeostasis, and seems to be a key target for anti-diabetic renal fibrosis.

Objective To investigate the diagnostic value of B7-H3 and carcinoembryonic antigen (CEA) on diagnosis of malignant pleural effusion (MPE).Methods We collected and analysed the expression of B7-H3 and CEA in 40 MPE cases and 22 cases of benign pleural effusion (BPE) using enzyme-linked immunosorbent assay (ELISA).Receiver operator characteristic curves (ROC) were drawn according to the expression of B7-H3 and CEA, calculated diagnosis sensitivity, specificity and the area under curve (AUC).Results The diagnosis sensitivity of B7-H3 was 62.5％, specificity 81.0％, with the AUC of 0.777;similarly, The diagnosis sensitivity of CEA was 72.5％, specificity 81.0％, with the AUC of 0.850.Higher AUC of 0.910 was gained in combination ROC, with sensitivity and specificity of 72.5％, 81.0％, respectively.Conclusion B7-H3 and CEA could be available diagnosing markers for MPE.Combined applications of B7-H3 and CEA have higher AUC.They may be widely applied in future clinical practice.

Objective To evaluate he significance of the Neutrophil-Lymphocyte Ratio(NLR)and the red blood cell(erythrocyte)distribution width(RDW)in distinguishing between simple and complex febrile seizures and evaluate the diagnostic values of NLR and RDW in febrile seizures. Methods Totally,100 patients aged between 6 months and 5 years diagnosed with febrile seizure were admitted to the emergency department of the hospital.Complete blood count obtained from the peripheral blood samples collected from the patients at admis-sion were evaluated. Results The average values of NLR for simple and complex seizure groups were 2.16 ± 1.26 and 3.62 ± 1.51 respectively.The average values of RDW for simple and complex seizure groups were 15.04 ± 1.73 and 16.89 ± 1.44,respectively.Using receiver operating characteristic curve(ROC),the sensitivity and specificity were 65.5% and 66.2%,respectively,with the area under the curve[AUC]of 0.670 when the cut-off value was 2.52 for NLR,and they were 62.1% and 59.3%,respectively,with AUC of 0.619 when the cut-off value was 16.47 for RDW. Conclusion NLR and RDW may provide clinicians with an insight into differentiation between simple and complex febrile seizures,however,we need much better diagnostic value to classify the febrile seizures

Objective To investigate the correlation of serum brain derived neurotrophic factor (BDNF),visceral adipose and cognitive dysfunction in elderly patients with type 2 diabetes.Methods From July 2016 to August 2017,72 patients with type 2 diabetes in our department of inpatient were selected as subjects.According to whether there was cognitive dysfunction,they were divided into 2 groups,type 2 diabetes mellitus combined with cognitive impairment group (A group) and simple type 2 diabetes group (B group).Another 40 healthy persons in the same period were selected as the control group.The indexes of glycolipid metabolism,visceral adipose and BDNF were measured in two groups.The logistic regression analysis was used to analyze the risk factors of cognitive dysfunction,and the relationship between visceral adipose,BDNF and cognitive function was analyzed by Pearson correlation.Results (1) The total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),fasting insulin (FINS),fasting blood glucose (FPG),glycosylated hemoglobin (HbA1c),fasting insulin (FINS),insulin resistance index (HOMA-IR),and visceral fat hormone level of the three groups were from high to low in A group ＞ B group ＞ C group (P ＜ 0.05);while the high density lipoprotein cholesterol (HDL-C),the expression level of BDNF and Montreal Cognitive Assessment (MoCA) score of the three groups were from high to low in C group ＞ B group ＞ A group (P ＜ 0.05);(2) The logistic regression analysis showed that visfatin,HOMA-IR,BDNF for the risk of cognitive impairment factors in elderly patients with type 2 diabetes;(3) Correlation analysis showed that the score and visceral fat MoCA and HOMA-IR were negatively correlated with the MoCA score was positively related to BDNF;HOMA-IR and visfatin was positively correlated,negatively correlated with BDNF.Conclusions The cognitive function of elderly patients with type 2 diabetes is related to serum visfatin and BDNF.Increased visfatin and BDNF may lead to cognitive dysfunction.

Intestinal flora can participate in and influence the physiological function and disease process of the organism as part of the host .The symbiotic relationship between intestinal flora and the host is the result of species′evolution over millions of years .Immunity system , which is complex and includes multiple influencing factors , is the necessary defense system that runs through human life .Among them, the intestinal flora plays an important role in maintaining the steady state of human immunity system .In this paper, the relationship between intestinal flora and immune system disease is briefly described , in order to deepen the understanding for medical workers and researchers , and provide references for the prevention , treatment and prognosis of the disease .

Objective To explore the differences of using different analytic quality requirements in the comparable validation of blood cell analysis multi-system range test comparable schemes for establishing appropriate analysis quality standards for laboratory.Methods According to WS/T 407-2012 Guideline for Comparability Verification of Quantitative Results in Medical Institution,the range test comparable method was established.According to different sources of analytic quality requirements from the WS/T 406-2012 Analysis Quality Requirements of Clinical Hematological Detection Routine Items,the US Clinical Laboratory Improvement Amendment (88),GB/T 20470-2006 Requirements of External Quality Assessment for Clinical Laboratories and biological variations,corresponding analysis quality requirements standard was designed.Results With the standards designed by using WS/T 406-2012,CLIA′-88 and GB/T 20470-2006 as the analysis quality requirements,only the comparison results of low concentration levels in 3 items of HBC,PLT and HCT were not passed,while other results all were passed;all results passed the consistency verification by suitably revising the analytic quality requirements of low value concentrations.With the biological variations as the analysis quality requirement,the comparison results in WBC three concentration levels,and HBG high and low concentration levels were passed,but other results were not passed.Conclusion The biological variations analytical quality requirements are relative demanding.Using WS/T 406-2012 Analysis Quality Requirements of Clinical Hematological Detection Routine Items and GB/T 20470-2006 Requirements of External Quality Assessment for Clinical Laboratories,fully considering the suitability of low concentration quality requirements and formulating appropriate analysis quality standards of laboratory are the important contents of laboratory comparable validation scheme.

Objective To explore the diagnostic value of C‐reactive protein(CRP) for diagnosing chronic obstructive pulmonary disease(COPD) to dig a new marker for COPD diagnosis .Methods A total of 199 cases of COPD ,159 cases of pulmonary malig‐nant tumor and 115 individuals undergoing the physical examination were collected .The whole blood CRP level was detected in 3 groups and the detection results were compared among 3 groups .The receiver operating characteristic(ROC) curve was drawn . Then the sensitivity ,specificity and Youden′s index(YI) were calculated to find the cut‐off value of diagnosis .Results Compared with the individuals undergoing healthy physical examination ,the CRP level in the COPD patients and the patients with pulmonary malignant tumor was significantly increased ,the difference was statistically significant(P<0 .05);the area under ROC curve(AUC) was 0 .768 ,the maximal YI was 0 .418 ,the sensitivity and specificity were 64 .7% and 77 .1% respectively ,the corresponding cut‐off value was 49 .75 mg/L .Conclusion CRP has a certain diagnostic value and can serve as a new index of COPD diagnosis .