Objective:To investigate the impact of small extracellular vesicles(sEVs) derived from perirenal adipose cells on the biological behavior of renal tubular epithelial cells under diabetic conditions and the underlying molecular mechanisms.Methods:Primary perirenal adipose cells were extracted from db/m and db/db mice for in vitro culture. The culture supernatant was collected and sEVs(NDM-sEVs PRAT-Adipo, DM-sEVs PRAT-Adipo) were extracted by ultracentrifugation. The sEVs were incubated with human renal tubular epithelial cell line(HK-2) to observe changes in their proliferation, apoptosis, autophagy, and epithelial-mesenchymal transition(EMT) levels. The protein composition of sEVs was analyzed using mass spectrometry to explore the molecular mechanisms. Results:CCK8 results showed that the proliferation level of HK-2 cells after DM-sEVs PRAT-Adipo intervention did not change significantly compared with the two control groups(Ctrl group and NDM-sEVs PRAT-Adipo intervention group). Western Blot(WB) results indicated that there were no significant changes in apoptosis levels(Bcl-2, Cleaved-caspase 3, Caspase 3) and autophagy levels(p62, LC3BⅠ, LC3BⅡ) in the DM-sEVs PRAT-Adipo intervention group compared with the two control groups. WB and immunofluorescence results demonstrated that DM-sEVs PRAT-Adipo intervention upregulated the expression levels of mesenchymal cell marker proteins(Vimentin, α-SMA, Snail2) and downregulated the expression level of epithelial cell marker protein ZO-1 in HK-2 cells compared with the two control groups. Mass spectrometry analysis of sEVs revealed that the differential proteins between DM-sEVs PRAT-Adipo and NDM-sEVs PRAT-Adipo were enriched in EMT-related pathways. Among them, the enrichment of thrombospondin(THBS1) in DM-sEVs PRAT-Adipo might be involved in the regulation of EMT in HK-2 cells. Conclusion:Under diabetic conditions, sEVs secreted by PRAT-derived adipocytes promote the upregulation of EMT in renal tubular epithelial cells, a process that may be mediated by the enrichment of THBS1 in sEVs.

【Objective】 To study the correlation between platelet transfusion efficacy and KIR receptor-HLA ligand. 【Methods】 Thirty-three leukemia patients with positive HLA antibody were tested for cross-matching with donor platelets. Platelets from suitable donors were selected for transfusion, and the 24-hour platelet corrected count increment (CCI) was used to determine the transfusion effect. KIR and ligand genotyping were performed on blood samples from patients and donors by PCR-SSP method, and the relationship between platelet transfusion effects and KIR receptor-HLA ligand was analyzed. 【Results】 In 74 occasions of platelet transfusion, 42 were ineffective and 32 were effective. When the donor had C2 gene and HLA-B Bw4-80T gene, the frequency of ineffective platelet transfusion in the recipient was 69.0% (29/42) and 52.4% (22/35), respectively, which was significantly higher than that in the effective group [25.0% (8/32) and 25.0% (8/32)]. When the donor had C1 gene, and the frequency of effective platelet transfusion in the recipient was 100.0%(32/32), which was higher than that in the ineffective group [83.3%(35/42)]. When the recipient-donor matching mode was KIR2DL1-C2 and KIR3DL1-(HLA-B Bw4-80T), the frequency of ineffective platelet transfusion was 69.0%(29/42) and 40.5%(22/42),higher than that of the effective group [25% (8/32) and 18.8% (6/32)]. When the recipient-donor matching model was KIR2DL3-C1, the rate of effective platelet transfusion in 32 patients (100.0%), which was higher than that (35 patients 83. 3%) in the ineffective group. When the mismatch mode of recipient iKIR+donor HLA ligand receptor was KIR2DL1-C2, the frequency of effective platelet transfusion in the recipient was 78.1% (25/32), which was much higher than that in the ineffective group [31.0% (13/42)]. When the mismatch mode was KIR3DL1-(HLA-B Bw4-80T), the rate of effective platelet transfusion in the recipient was 68.8% (22/32), which was higher than that in the ineffective group (42.9%, 18/42). The difference between the above groups was statistically significant(P<0.05). 【Conclusion】 HLA-C1 and HLA-C2 genes are the key factors affecting the efficacy of platelet transfusion.For platelet refractorines, HLA-C1 is the protective gene, while HLA-C2 and HLA-B Bw4-80T are the susceptible genes. The recipient iKIR+donor HLA ligand receptor model may play an important role in platelet refractoriness.

Objective:To test the reliability and validity of a multi-dimensional, quantitative video evaluation system (the Multi-dimensional system) for evaluating hand dysfunction among stroke survivors so as to provide an objective basis for its clinical application.Methods:Sixty stroke survivors with single dysfunctional hand were evaluated using the Multi-dimensional system and also using the Fugl-Meyer Upper Extremity Assessment (FMA-UE) and the Action Research Arm Test (ARAT) and in terms of their active range of hand motion (AROM-H). The Multi-dimensional system′s internal consistency, composite reliability, split-half reliability, parallel-forms reliability as well as intra- and inter-observer reliability were quantified. Its validity was tested in terms of content validity, structural validity, convergent validity and criterion validity.Results:The system′s Cronbach′s α was determined to be 0.86. Its one-dimension composite reliability was 0.939, its split-half reliability coefficient was 0.88 and its parallel-forms reliability was 0.922. The inter-evaluator reliability was between 0.965 and 0.998 [95%CI= (0.919, 0.999)], and the single evaluator ICC value was 0.973 to 0.998 [95%CI= (0.937, 0.999)]. The validity test produced a content validity index of 1, and the Pearson correlation coefficients between each sub-item and the total score were all greater than 0.60. The KMO value for structural validity was 0.882, and there was a common factor in the component matrix which reflected 60.9% of the information in the original variables. The system′s convergent validity AVE was 0.609 with Pearson correlation coefficients between the multidimensional system and the FMA-UE and ARAT both > 0.70.Conclusion:The multi-dimensional quantitative video evaluation system has good reliability and validity in the evaluation of stroke survivors with hand dysfunction.

Objective:To investigate the relationship between serum Betatrophin levels and metabolic parameters in patients with polycystic ovary syndrome (PCOS) .Methods:98 patients with PCOS (PCOS group) treated in Zhengzhou People’s Hospital from Dec. 2017 to Sep. 2019 were selected. They were divided into non-obese group ( n=45) and obese group ( n=53) according to BMI value; They were divided into non-IR group ( n= 21) and IR group ( n=77) according to HOMA-IR value; They were divided into non-hyperandrogen group ( n=24) and hyperandrogen group ( n=74) according to TT level; Another 90 healthy women were taken as the control group. The baseline data, lipid metabolism indexes, hormone indexes, glucose metabolism indexes and Betatrophin levels of the two groups were recorded. Pearson test and logisitc regression model were used to analyze the influencing factors related to the increase of serum Betatrophin level in patients with PCOS. Results:Compared with the control group, PCOS group had higher level of BMI, body fat, WHR, VLDL, LDL, TG, TC, FAI, TT, LH, DHEA-S, 17-OHP, FSH, FBG, FINS, and HOMA-IR, while the HDL level was significantly lower. The difference was significant ( P<0.01). Serum Betatrophin level in obese group was significantly higher than that in the control group (163.99±126.97 vs 110.99±102.97), and the difference was statistically significant ( t=3.21, P<0.001) ; serum Betatrophin level in IR group was higher than that in the control group (160.26±136.80 vs 133.17±112.06), and the serum Betatrophin level in IR group was higher than that in the control group (173.51±147.85 vs 144.26±124.56), but the difference was not statistically significant ( P>0.05). Serum Betatrophin levels in PCOS group were positively correlated with BMI, WHR, TG, FAI, FBG, FINS ( P<0.05), and negatively correlated with HDL ( P<0.05). Logistic analysis showed that BMI, WHR and TG were independent factors affecting the increase of serum Betatrophin level. Conclusion:Serum Betatrophin levels of PCOS patients are significantly increased, and BMI, WHR, TG, HDL, FAI, FBG, FINS may play an important role in the occurrence and development of PCOS and obesity, insulin resistance, blood lipids and androgen metabolism disorders.

Group A Streptococcus (GAS) is a very important pathogen, especially for children.On a global scale, GAS is an important cause of morbidity and mortality.But the burden of disease caused by GAS is still unknown in China and also has not obtained enough attention.For this purpose, the expert consensus is comprehensively described in diagnosis, treatment and prevention of GAS diseases in children, covering related aspects of pneumology, infectiology, immunology, microbiology, cardiology, nephrology, critical care medicine and preventive medicine.Accordingly, the consensus document was intended to improve management strategies of GAS disease in Chinese children.

  Objective  To study the demographic and clinical characteristics, correlation of genotype and phenotype and treatment of Blau syndrome to facilitate early diagnosis and timely treatment of Blau syndrome.  Methods  Seventy-two patients with Blau syndrome from 11 centers from May 2006 to April 2022 were retrospectively analyzed, and their general information, clinical data, laboratory examination and treatment medication were collected.  Results  The distribution of patients with Blau syndrome was uniform in geographical north and south of China, and there was no obvious gender bias. The mean age of onset was (14.30±12.81) months, and the age of diagnosis was (55.18±36.22) months. 35% of patients with Blau syndrome happened before 1 year old, and all patients developed before 5 years old. 87.50% (63/72) had granulomatous arthritis, 65.28% (47/72) had rash, 36.11% (26/72) had ocular involvement, 27.78% (20/72) had fever, and 15.28% (11/72) had pulmonary involvement. Arthritic manifestations of Blau syndrome were most at risk, followed by rash, ocular involvement, and fever.The first 25 months of the disease, the risk of developing a rash was the greatest. The risk of developing arthritis was the greatest between 25 months and 84 months. The main mutations were p.R334Q and p.R334W, and patients with p.R334Q mutation had relatively high incidence of fever (35.71%[5/14] vs. 14.29%[1/7], P=0.43) and ocular involvement (42.86%[6/14]vs. 28.57%[2/7], P=0.51). There was a relatively high incidence of rash (85.71%[6/7] vs. 64.29%[9/14], P=0.59) in patients with the p.R334W mutation. Forty-five patients(62.50%)were treated with a combina-tion of glucocorticoid and methotrexate. Twenty-two patients were treated with tumor necrosis factor antagonist in addition to glucocorticoid and methotrexate.  Conclusions  The risk of different clinical manifestations of Blau syndrome from high to low was arthritis, followed by rash, ocular involvement and fever. The main treatment was glucocorticoid combined with methotrexate, to which biological agents could be added.

Objective To study the impact of brief intervention on HPV cognition of medical students in Xinjiang, and to provide a reference for the development of HPV related education in medical students. Methods Sudents from 20 classes of a medical university in Xinjiang were randomly selected. The first 10 classes were enrolled into group 1, which was a self-controlled study group evaluating the effect before and after intervention. The other 10 classes were included in group 2, in which students in each class were randomly divided into control group (filling in questionnaires before the intervention) and intervention group (filling in questionnaires after the intervention). Medical students were given a 10 minutes presentation on the intervention of HPV by trained personnel. Results (1) For HPV related knowledge, the difference in the awareness rates between the two groups before and after intervention was statistically significant (P < 0.001), and the awareness rate after intervention was higher than that before intervention. Before the intervention, the awareness rates of medical students in group 1 and group 2 were 18.67% and 17.71%, respectively, which increased to 66.75% and 52.85% after the intervention (P<0.01). (2) Regarding HPV-related attitudes and behavioral content, the differences in the response results of the two groups of students before and after the intervention were statistically significant (P<0.05), showing a more positive state after the intervention. Before the intervention, there were 86.19% and 88.02% of the students in group 1 and group 2 willing to publicize HPV-related knowledge to their relatives and friends, and the numbers increased to 94.12% and 94.82%, respectively, after the intervention (P < 0.05). Conclusion Both self-controlled and parallel-controlled studies demonstrated that brief interventions improved medical students' awareness of HPV.

Objective:To explore the current situation of innovation ability of clinical nurses in Guizhou Province and its influencing factors so as to provide a theoretical basis for nursing managers to evaluate and carry out training for innovation ability among nurses.Methods:In April 2019, this study selected totals of 24 Class Ⅲ hospitals, 50 Class Ⅱ hospitals and 60 ClassⅠ hospitals in Guizhou Province by stratified random sampling to carry out investigation with the method of cross-sectional survey. A total of 5 161 clinical nurses were randomly selected in each hospital according to the scale. Electronic questionnaire was designed, and WeChat link as well as two-dimensional code was developed by the Questioning Star software to investigation in the form of network. A total of 5 161 questions were collected and 5 145 of them were valid with 99.69% for the valid recovery rate. Excel was used to build the original database, SPSS 18.0 was used for analysis. Influencing factors were analyzed with the multiple linear regression.Results:Among 5 145 clinical nurses in Guizhou Province, the total score of innovation ability was (129.63±24.30) with the intermediate level. Simple correlation showed that there were statistical differences in the scores of innovation ability among clinical nurses with different hospital levels, departments, ages, working lives, marital status, educational levels, positional titles, posts, monthly incomes, satisfaction with work, support for work from family members, employment forms, whether teaching and participating in scientific research ( P<0.05) . Multiple linear regression analysis showed that the importantly influencing factors of innovation ability of clinical nurses included the satisfaction with work, support for work from family members, whether participating in scientific research, working lives, job title, hospital levels, whether teaching, monthly incomes with statistical differences ( P<0.05) . Conclusions:Clinical nurses of Guizhou Province have the intermediate level of innovation ability needed to be improved. Nursing managers should strengthen the innovation knowledge training and resource support for clinical nurses, encourage them positively to take part in continuing education so as to improve the innovation will and ability of clinical nurses in Guizhou Province.

Objective To observe the influence of glucose fluctuation on paraoxonase-3(PON3) and apoprotein A1(ApoA1) in T2DM patients with coronary heart disease (CHD) . Methods A total of 260 subjects were enrolled in this study and dividied into three groups :T2DM patients with CHD (T2DM +CHD group ,n=100) ,T2DM without CHD (T2DM group ,n=80) and healthy subjects(NC group ,n=80) .The serum PON3 and ApoA1 levels were measured and compared in all the three groups .The 72 h dynamic glucose monitoring (CGMS ) was adopted in T2DM + CHD group ,then according to the MAGE levels ,T2DM+ CHD group was subdivided intotertiles :the lowest tertile subgroup (2.43～3.44 mmol/L ,n=31) ,the middle tertile subgroup (3.45～4.46 mmol/L ,n=39) and the highest tertile subgroup (4.47～5.45 mmol/L ,n= 30) .Influencing factors for PON3 and ApoA1 were analyzed by multivariate linear regression analysis . Results (1)The SBP ,DBP ,FPG ,2 hPG ,HbA1c ,FIns ,ApoB ,BUN ,HOMA-IR , ApoA1 and number of smokers were higher in T2DM + CHD group than in NC group .FPG ,2 hPG ,HbA1c ,FIns and HOMA-IR were higher in T2DM+ CHD group than in T2DM group(P<0.05 or P<0.01) .LDL-C ,Lp-a and hsC-RP were higher ,and the PON3 were lower in T2DM +CHD group than in T2DM group and NC group (P< 0.05 or P< 0.01);(2)With the increase of blood glucose fluctuation range ,the levels of PON3[(0.58 ± 0.10) vs (0.44 ± 0.07) vs (0.25 ± 0.01) ng/ml]and ApoA1 [(2.33 ± 1.04) vs (2.31 ± 0.71) vs(1.05 ± 0.48)g/L]were reduced(all P=0.000);(3)Multiple linear regression analysis showed that BMI ,hsC-RP ,HOMA-IR and MAGE were influencing factors for PON3. And HbA1c ,hsC-RP and MAGE were influencing factors for ApoA1 (P<0.05 or P<0.01) . Conclusion Serum PON3 level is lower and ApoA1 level is higher in T2DM patients with CHD .Glucose fluctuation may be only an influencing factor for ApoA1 level .

Twelve novel 2-cyano-3,12-dioxooleana-1,9(11)-dien-28-oic acid(CDDO) derivatives were designed and synthesized(9a-91) by introducing different heterocyclic rings to 17-COOH of CDDO through various linkers.Their structures were determined by ESI-MS,IR and 1 H NMR.The antiproliferative activity of the synthetic derivatives against human cancer cells HCT-116,A549 and HepG2 was evaluated by MTT assay.Several compounds showed potent inhibitory activities against test cell lines.Among them,compound 9c showed more potent antiproliferative activity than the CDDO-imidazolide (CDDO-Im).Moreover,rat plasma stability assay showed that compound 9c was more stable than CDDO-Im.