BACKGROUND:In recent years,with the rapid development of biomedicine,the study of brain aging and exosomes has attracted more and more attention,but there is no bibliometrics analysis in this field. OBJECTIVE:To objectively analyze domestic and foreign literature on brain aging and exosomes in the past 15 years,to summarize the research status,hot spots,and development trends in this field. METHODS:Using the core database of Web of Science as a search platform,we downloaded the literature on brain aging and exosomes published from the establishment of the database to December 28,2022,and analyzed the data from the aspects of country or region,institution,author,keywords,and co-cited literature using CiteSpace 6.1.R6 visualization software. RESULTS AND CONCLUSION:A total of 1 045 research articles were included,and the number of publications on brain aging and exosomes research both domestically and internationally was showing an increasing trend year by year.The United States ranked first with 429 papers,and China ranked second with 277 papers.Louisiana State University ranked first with 16 articles.Professor Lukiw Walter J from Louisiana State University in the United States was the author with the highest number of publications,and Professor Bartel DP from the Massachusetts Institute of Technology was the author with the most citations.The most prolific Journal was the International Journal of Molecular Sciences.Alzheimer's disease,microRNA,gene expression,extracellular vesicles,exosomes,oxidative stress,and biomarkers are the most relevant terms.According to the research on hot topics,biomarkers have become a new research hotspot.The above results indicate that the research on brain aging and exosomes has gradually increased in the past 15 years.The research direction has gradually shifted from the initial exploration of the expression of miRNAs in central nervous system diseases related to brain aging to the search for biomarkers that can identify and diagnose neurodegenerative diseases.The study of exocrine miRNAs to protect central nervous system from damage has emerged as promising therapeutic strategy.

OBJECTIVE:To systematically evaluate the effects of high-intensity interval training(HIIT)and moderate-intensity continuous training(MICT)on body composition and glucose metabolism-related indexes in overweight or obese patients with type 2 diabetes and to compare the improvement effect of the two exercise modalities,thereby providing a reference basis for the development of exercise prescription for overweight or obese patients with type 2 diabetes. METHODS:The Cochrane Library,PubMed,EMbase,Web of Science,CNKI,CBM,WanFang,and ClinicalTrials.gov were searched for randomized controlled trials comparing the effects of HIIT and MICT interventions on body composition and glucose metabolism-related indicators in overweight or obese patients with type 2 diabetes.The search was conducted from database inception to June 2022.Meta-analysis of outcome indicators was performed using RevMan 5.4. RESULTS:(1)A total of 13 randomized controlled trials with 371 subjects were included,and the overall quality of the included studies was relatively high.(2)There was no significant difference in the improvement of body composition between HIIT and MICT[body mass:weighted mean difference(WMD)=2.44,95%confidence interval(CI):-3.01-7.89,P＞0.05;body mass index:WMD=0.28,95%CI:-1.21-1.77,P＞0.05;waist circumference:WMD=2.16,95%CI:-2.04-6.35,P＞0.05;body fat percentage:WMD=0.47,95%CI:-2.11-3.05,P＞0.05).(3)The results of subgroup analysis showed that there was a significant difference in body mass and body mass index between the"training cycle≥12 weeks"subgroup and the"training frequency≤3 times/week"subgroup(training cycle≥12 weeks subgroup:WMD=4.25,95%CI:0.90-7.59,P=0.01;WMD=2.71,95%CI:1.92-3.51,P＜0.000 01;training frequency≤3 times/week subgroup:WMD=5.14,95%CI:1.7-8.57,P=0.003;WMD=1.67,95%CI:0.66-2.67,P=0.001).(4)The results of sensitivity analysis showed that there was a significant difference in body fat percentage between the HIIT and MICT groups(WMD=2.17,95%CI:1.20-3.14,P＜0.000 1),while there was no significant difference in the improvement of glucose metabolism between the HIIT and MICT groups(fasting blood glucose:WMD=0.31,95%CI:-0.17-0.79,P＞0.05;glycosylated hemoglobin:WMD=0.01,95%CI:-0.19-0.20,P＞0.05;insulin resistance index:WMD=-0.14,95%CI:-0.71-0.42,P＞0.05).(5)The results of subgroup analysis showed that fasting blood glucose was significantly different in the subgroup of"training frequency≤3 times/week"(WMD=0.92,95%CI:0.25-1.60,P=0.007)and glycosylated hemoglobin was significantly different in the"training frequency＞3 times/week"subgroup(WMD=-0.2,95%CI:-0.3 to-0.1,P＜0.000 1). CONCLUSION:Overall,there is no significant difference between HIIT and MICT in improving body composition such as body mass,body mass index,waist circumference,body fat percentage as well as improving glucose metabolic indexes such as fasting blood glucose,glycated hemoglobin and insulin resistance index in overweight or obese patients with type 2 diabetes.When the training period is≥12 weeks and the training frequency is≤3 times/week,MICT has a better effect on the improvement of body mass as well as body mass index.

OBJECTIVE To explore the expression of trefoil factor family peptide(TFF3)in chronic rhinosinusitis with nasal polyps(CRSwNP)and its regulation on mucin 5AC(MUC5AC)expression.METHODS The nasal polyp tissues of 16 patients in the CRSwNP group and the nasal mucosal tissues of 16 patients in the control group were selected,and the expressions of TFF3 and MUC5AC were detected by quantitative real-time polymerase chain reaction(RT-qPCR)and Western blot,and the correlation between them was analyzed.The human nasal epithelial cell(HNEpC)line with TFF3 knockdown was constructed,and the expression of MUC5AC in KD-TFF3 HNEpC was detected by RT-qPCR and immunofluorescence.RESULTS The expression level of TFF3 in nasal polyps was significantly lower than that of control group,and the expression level of MUC5AC was increased,and the expression level of both was negatively correlated(r=-0.556,P<0.05).The expression of MUC5AC in KD-TFF3 HNEpC was significantly higher than that in control group.CONCLUSION The expression of TFF3 decreases in CRSwNP and negatively regulates the expression of MUC5AC.This study provides a new idea for the treatment of abnormal hypersecretion of mucous in chronic nasal inflammatory diseases represented by CRSwNP.

Background::The potential impact of pre-existing coronary artery stenosis (CAS) on acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I (hs-cTnI) levels in patients with PE.Methods::In this multicenter, prospective case-control study, 88 cases and 163 controls matched for age, sex, and study center were enrolled. Cases were patients with PE with elevated hs-cTnI. Controls were patients with PE with normal hs-cTnI. Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results::The percentage of CAS was higher in the case group compared to the control group (44.3% [39/88] vs. 30.1% [49/163]; P = 0.024). In multivariable conditional logistic regression model 1, CAS (adjusted odds ratio [OR], 2.680; 95% confidence interval [CI], 1.243–5.779), heart rate >75 beats/min (OR, 2.306; 95% CI, 1.056–5.036) and N-terminal pro-B type natriuretic peptide (NT-proBNP) >420 pg/mL (OR, 12.169; 95% CI, 4.792–30.900) were independently associated with elevated hs-cTnI. In model 2, right CAS (OR, 3.615; 95% CI, 1.467–8.909) and NT-proBNP >420 pg/mL (OR, 13.890; 95% CI, 5.288–36.484) were independently associated with elevated hs-cTnI. Conclusions::CAS was independently associated with myocardial injury in patients with PE. Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.

Objective:To summarize the genotype and clinical characteristics of chylomicron retention disease (CMRD) caused by secretion associated Ras related GTPase 1B (SAR1B) gene variations.Methods:Clinical data and genetic testing results of 2 children with CMRD treated at Children′s Hospital of Fudan University and Jiangxi Provincial Children′s Hospital from May 2022 to July 2023 were summarized. To provide an overview of the clinical and genetic characteristics of CMRD caused by SAR1B gene variations, all of the literature was searched and reviewed from China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China VIP database, China Biology Medicine disc and PubMed database (up to January 2024) with "chylomicron retention disease" "Anderson disease" or "Anderson syndrome" as the search terms. All relevant literatures were reviewed to summarize the clinical and genetic features of CMRD caused by SAR1B gene variations.Results:One 11-year-old boy and one 4-month-old girl with CMRD. Both patients had lipid malabsorption, failure to thrive, decreased cholesterol, elevated transaminase and creatine kinase, and Vitamin E deficiency, with homozygous variations (c.224A>G) and compound heterozygous variations (c.224A>G and c.554G>T) in SAR1B gene, respectively. Case 1 was followed up for over a month, and he still occasionally experienced lower limb muscle pain. Case 2 was followed up for more than a year, and her had caught up to normal levels. Both patients had no other significant discomfort. Literature search retrieved 0 Chinese literature and 22 English literatures. In addition to the 2 cases reported in this study, a total of 51 patients were identified as CMRD caused by SAR1B gene variations. Twenty-one types of SAR1B variants 10 missense, 4 nonsense, 3 frameshift, 1 in-frame deletion, 1 splice, 1 gross deletion, and 1 gross insertion-deletion were found among the 51 CMRD cases. Among all the patients, 49 cases had lipid malabsorption (43 cases had diarrhea or fatty diarrhea, 17 cases had vomiting, and 12 cases had abdominal distension), 45 cases had lipid soluble Vitamin deficiency (43 cases had Vitamin E deficiency, 10 cases had Vitamin A deficiency, 9 case had Vitamin D deficiency, and 5 cases had Vitamin K deficiency), 35 cases had failure to thrive, 32 cases had liver involvement (32 cases had elevated transaminases, 5 cases had fatty liver, and 3 cases had hepatomegaly), 29 cases had white small intestinal mucosa under endoscopy, and 17 cases had elevated creatine kinase, 14 cases had neuropathy, 5 cases had ocular lesions, 2 cases had acanthocytosis, 1 case had decreased cardiac ejection fraction, and 1 case was symptom-free.Conclusions:Early infancy failure to thrive and lipid malabsorption are common issues for CMRD patients. The laboratory tests are characterized by hypocholesterolemia with or without fat-soluble Vitamin deficiency, elevated liver enzymes and (or) creatine kinase. Currently, missense variations are frequent among the primarily homozygous SAR1B genotypes that have been described.

Objective To explore the risk factors for the returning of pediatric liver transplant recipi-ents to the intensive care unit(ICU)and provide reference for the clinical decision-making after surgery.Methods A retrospective analysis was conducted with the information of all the pediatric patients who underwent liver transplantation in Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine and were returned to the ICU from 2019 to 2021.The patients returned to the ICU during hospitalization and the reasons for the return were recorded.Each patient of ICU return was matched with three pediatric patients who did not return to the ICU during hospitalization.The basic information,the vital signs and laboratory indicators on the day of transfer from ICU,immunosuppressants and drug concentrations were compared between the two groups.Multivariate Logistic regression analysis was performed to explore the risk factors for the returning of pediatric liver transplant recipients to the ICU.Results The returning rate of pediatric liver transplant recipients to the ICU was 4.36％,and it was 16.00％within 48 h.The main reasons for the return included respiratory complications,abdominal infections,and hepatic vascular occlusion.Multivariate Logistic regression analysis showed that post-operative red blood cell transfusion(OR=4.554,95％CI=1.743-11.901,P=0.002)and high serum level of uric acid(OR=1.005,95％CI=1.001-1.009,P=0.014)were the risk factors for returning to the ICU.High diastolic blood pressure(OR=0.922,95％CI=0.885-0.960,P＜0.001)and high total protein level(OR=0.937,95％CI=0.891-0.986,P=0.012)were the protective factors for returning to the ICU.Conclusion Post-operative red blood cell transfusion and high serum level of uric acid are independent risk factors for the returning of pediatric liver transplant recipients to the ICU.

Purpose To explore the value of iodine concentration(IC)and effective atomic number(Zeff)derived from dual-layer spectral detector CT in diagnosing the regional lymph nodes of gastric cancer.Materials and Methods From May 2021 to September 2022,108 patients pathologically confirmed with gastric cancer(92 non-metastatic lymph nodes and 116 metastatic lymph nodes),who underwent dual-phase enhanced dual-layer spectral detector CT scanning preoperatively in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,were included in the study.The imaging and clinical data of all cases were collected,retrospectively.According to preoperative CT images,the short diameter,margin and enhancement homogeneity of the lymph nodes were evaluated.The IC and Zeff were obtained from the delineated region of interest of the solid portion of the maximum layer of the target lymph nodes,and the normalization IC(nIC)and normalization Zeff(nZeff)were calculated.The difference of parameters between two groups were compared.The efficiency of differential diagnosis and combined diagnosis of each parameter was analyzed.The area under the receiver characteristic curve(AUC)for each parameter were compared.Results There were statistical differences in short diameter,margin and enhancement homogeneity between the two groups(t/x2=-7.575,30.971,20.913,all P＜0.001).In the benign lymph nodes group,all spectral parameters in the arterial phase(AP)were lower than those in malignant lymph nodes,while the parameters in the venous phase(VP)were higher(t=-10.723-12.610,all P＜0.001).Among the three conventional features,the AUC of short diameter was the highest(0.749).Compared with the AUC values of ICAP and ZeffVP,the AUC values of short diameter and quantitative parameters had no statistical difference(P＞0.05),but were lower than those of other spectral parameters.Among the spectral parameters,the AUC value of nICVP was the highest(0.925).The sensitivity and specificity of the spectral parameters were higher than those of conventional features.The diagnostic efficacy of the multi-parameter combined model was superior to that of the univariate model.The AUC value of the combined model with conventional features was 0.815.Among the combined model based on CT spectral parameters,the diagnostic efficacy of model combined with the parameters of arteriovenous phase was the highest(AUC=0.993).Conclusion The quantitative parameters of dual-phase enhancement derived from dual-layer spectral detector CT can effectively evaluate the characteristics of gastric cancer regional lymph nodes,and the diagnostic efficiency is higher than the conventional characteristics of lymph nodes.The multi-parameter combined model can improve the diagnostic efficiency.

To analyze the current quality of treatment for hospitalized cancer patients in Beijing, identify major issues in treatment practices, and propose improvements.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Objective:To explore the efficacy of digital and 3D printing technologies on design of superficial iliac circumflex artery flap for coverage the donor site of anterolateral thigh flap(ALTF).Methods:Clinical data of 8 patients were studied retrospectively for treatment of soft tissue defects of hand in the Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, from April 2017 to October 2021. The patients were 6 males and 2 females, aged from 29 to 59 years(mean, 45.8 years). Cause of injury: 3 patients were crushed, 2 by hot pressing, and 3 by machine strangulation. Site of injury included: 5 cases were dorsal hand defects and 3 cases were palm defects. All the wounds were contaminated to varying degrees with soft tissue defects. The areas of soft tissue defect ranged from 11 cm×10 cm to 22 cm×14 cm. Four patients had combined injuries of open fracture of metacarpals and phalanges and 3 with tendon defects. All wounds were repaired by free ALTF transplantation. And the donor sites in the thigh were repaired by superficial iliac circumflex artery flaps. The secondary wounds caused by flap harvesting on abdominal wall were closed directly. The targeted perforator vessels were detected preoperatively by CTA combined with CDU. 3D printed models of the affected hand were obtained before operation for individualised repairs according to the shape and area of the wounds. After the operation, all patients entered scheduled follow-ups at the outpatient clinic and via internet by observing the flap shape and testing the recovery of sensory and movement of adjacent joint.Results:The shapes and sizes of the wounds and the flaps were found basically in accordance with those in the preoperative simulative designs. All flaps in 8 patients survived and the wounds healed completely. All patients entered follow-ups for 8 to 24(average, 17.5) months. The donor thighs presented good appearance and colour, pliability without bloating. The range of motion of the hips and knees was not affected. Only linear scars remained in the abdominal donor sites, with natural colour and appearance.Conclusion:Digital and 3D printing technologies in preoperative design of flaps can help to locate the perforator vessels intraoperatively and guide the individualised design of the flaps with improved operation efficiency and satisfactory appearance of the flaps.