Objective:To explore the potential pathogenesis of exosome-mediated polymyositis/dermatomyositis (PM/DM) through multi-omics combined with bioinformatic analysis approach and to identify potential new targets for the diagnosis and treatment of PM/DM.Methods:Collect serum exosome samples from PM/DM patients and healthy individuals who underwent physical examination in Wuxi Second People′s Hospital from January 2021 to June 2023. HiSeq high-throughput sequencing technology and iTRAQ quantitative proteomics techniques were used to perform a sequencing analysis of miRNA and protein components in serum exosomes from patients with PM/DM and healthy control. R language was adapted to conduct the limma differential analysis, gene ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG), gene set enrichment analysis (GSEA) functional analysis, and immunological correlation analysis. Based on these analysis, we identified core genes and established a miRNA-target gene-transcription factor co-expression molecular network. Subsequently, we employed quantitative real-time PCR (qRT-PCR) to experimentally validate the core genes. Data analysis was performed using t-test statistical analysis and receiver operating characteristic (ROC) curves were plotted to evaluate the test efficacy of the core genes. Results:Initially, 42 up-regulated differential proteins and 61 DEP down-regulated differential proteins, as well as 22 up-regulated differential miRNAs and 19 down-regulated miRNAs were screened, and 7 core genes, 13 associated differential miRNAs, and 4 transcription factors were finally identified. Based on the functional analysis we concluded that the core genes CTSG, MPO, H1-5 involved in the formation of neutrophil extracellular trap network, NF-κB pathway and other inflammation-related pathways might play an important role in exosome-mediated PM/DM pathogenesis. Immune cells such as mast cells, immature dendritic cells, natural killer cells, regulatory T cells, and helper T cells 2 were expressed to a higher extent in the disease. In the t-test, MPO [(1.08 ±0.47) vs. (2.05 ±0.62), t=-3.50, P=0.004], CTSG [(1.11 ±0.51 ) vs. (2.27 ±1.10 ), t=-2.72, P=0.022], and H1-5 [(1.03 ±0.25) vs. (1.81 ±0.73), t=-2.89, P=0.019] showed statistically significant differences. In the ROC curve analysis, MPO[AUC(95% CI): 0.92(0.78, 1)], CTSG [AUC(95% CI): 0.81(0.59, 1)], and H1-5 (AUC (95% CI)= 0.84(0.64, 1)] indicated that the three core genes had good accuracy. Conclusion:We identified the key differential molecules in serum exosomes of patients with PM/DM, and constructed a regulatory network of miRNA-target gene-transcription factor, and determined that the pathogenic mechanism of PM/DM was mediated by serum exosomes was mediated through the formation of neutrophil extracellular trapping nets and the NF-κB pathway. CTSG, MPO, and H1-5 are the core genes in the these pathways, and their related miRNAs and transcription factors have been identified, which may become potential targets and biomarkers for the diagnosis and treatment of PM/DM.

Objective To observe of the effect of neurophysiological facilitation of respiration combined with external diaphragm pacing on the respiration of stroke survivors. Methods Sixty-four stroke survivors were divided randomly into a treatment group and a control group, each of 32. Both groups were given routine drugs, while the treatment group was additionally provided with an external diaphragm pacemaker. Those in the treatment group also received neurophysiological facilitation of respiration six times a week for 3 weeks. Before and after the treatment, ar-terial oxygen partial pressure (PaO2) was measured in both groups along with arterial carbon dioxide partial pressure (PaCO2), arterial oxygen saturation ( O2sat) and C-reactive protein (CRP). Ultrasonography was used to measure diaphragm mobility at the end of expiration and inspiration (Δm) , diaphragm mobility of the end of forced inspiration and expiration ( ΔM), and the difference of diaphragm thickness ( Δd). First second forced expiratory volume ( FEV), and maximum voluntary ventilation (FVC) were also measured. Results After the treatment, the average PaO2, PaCO2, O2sat, CRP, Δm, ΔM, FEV and FVC of the treatment group were all significantly better than before the treatment and better than those of the control group. Conclusion Neurophysiological therapy combined with an external diaphragm pacemaker can significantly improve the respiration of stroke survivors, reducing the risk of lung infection.

OBJECTIVE:To establish a method for the content determination of 8 metal elements in Propylgaclate and sodium chloride injection. METHODS:Microwave digestion-inductively coupled plasma mass spectrometry(ICP-MS) was adopted. Radiofrequency power was 1 530 W;cooling temperature was 4 ℃;collision gas was He gas;carrier gas was argon;flow rate of carrier gas was 1.08 L/min;integration time was 0.3 s;plasma gas flow rate was 15 L/min;the vacuum degree of quadrupole was 3.04×10－4 Pa;sampling cone aperture was 1.0 mm;interception cone aperture was 0.4 mm;the speed of sampling was 0.3 rps;data collection was repeated for 3 times. The microwave digestion power is 1 600 W,and the heating process is heated to 160℃at room temperature for 30 min,and maintained at 5 min,and then heated to 190 ℃ at a temperature of 5 ℃/min and maintained 45 min. RESULTS:The linear range of Mg and Al were 1-250 ng/mL;the linear range of Cr,Mn,Fe,Cu,Zn,Cd were 1-100 ng/ mL(all r≥0.999 0). The limits of detection were 0.063 6-1.785 0 ng/mL. RSDs of precision,stability and reproducibility tests were all lower than 4%. The recoveries were 89.65%-105.60%(RSD were 1.57%-3.98%,n＝9). RSDs of durablity were all lower than 12%. CONCLUSIONS:The method is simple,accurate,precise,stable,reproducible and durable. It can be used for content determination of 8 metal elements in Propylgaclate and sodium chloride injection.

Objective To explore the effect of diabetic liaison nurses on controlling blood sugar levels in patients with hyperglycemia in department other than endocrinology. Methods Four hundred diabetic patients with high blood sugar were selected from January to December, 2014 in department other than endocrinology. They were divided randomly into 2 groups equally:the control group and the observation group. The control group received traditional nursing care, while blood sugar management was carried out by diabetic liaison nurse in the observation group. Result Pre-discharge sugar metabolism in the observation group was significantly better than that in the control group (P<0.05). Conclusion The diabetic liaison nurses in other departments than the endocrinology department can help control blood sugar levels in patients with hyperglycemiain.

Objective Ti explire the effect if aspirin (ASA)in primary preventiin if car-diivascular events if patients with type 2 diabetes and ti reduce adverse effects if ASA thriugh the appripriate nursing interventiins.Methods A tital if 200 patients with type 2 diabetes were randimly divided inti experimental griup and cintril griup with 100 patients in each griup.Ex-perimental griup were given 100mg aspirin every day and the patients in cintril griup were given placebi inly.The changes if chemical cimpisitiin in serum,iccurrence rate if cardiivascular and remissiin if gastriintestinal symptims caused by taking ASA in experimental griup were recirded and analyzed.Results ASA can significantly reduce LDL,TG,TC and CRP levels and imprive HDL levels.The incidence rate if majir cardiivascular events in experimental griup were signifi-cantly liwer than that in the cintril griup except strike (P <0.05).After scientific and system-atic nursing,gastriintestinal symptims caused by taking ASA in the experimental griup were sig-nificantly relieved.Conclusion Diabetes patients can significantly reduce iccurrence if cardiivas-cular by taking ASA.Scientific,systematic and seamless nursing interventiin can apparently re-duce adverse reactiin in gastriintestinal symptims caused by taking ASA.

Objective Ti explire the effect if aspirin (ASA)in primary preventiin if car-diivascular events if patients with type 2 diabetes and ti reduce adverse effects if ASA thriugh the appripriate nursing interventiins.Methods A tital if 200 patients with type 2 diabetes were randimly divided inti experimental griup and cintril griup with 100 patients in each griup.Ex-perimental griup were given 100mg aspirin every day and the patients in cintril griup were given placebi inly.The changes if chemical cimpisitiin in serum,iccurrence rate if cardiivascular and remissiin if gastriintestinal symptims caused by taking ASA in experimental griup were recirded and analyzed.Results ASA can significantly reduce LDL,TG,TC and CRP levels and imprive HDL levels.The incidence rate if majir cardiivascular events in experimental griup were signifi-cantly liwer than that in the cintril griup except strike (P <0.05).After scientific and system-atic nursing,gastriintestinal symptims caused by taking ASA in the experimental griup were sig-nificantly relieved.Conclusion Diabetes patients can significantly reduce iccurrence if cardiivas-cular by taking ASA.Scientific,systematic and seamless nursing interventiin can apparently re-duce adverse reactiin in gastriintestinal symptims caused by taking ASA.

Objective To derive a questionnaire to assess the risk of developing motor complications through a 3-year prospective investigation on 71 patients of Parkinson' s disease (PD) in the out clinic at our hospital.Methods Three years after the first assessment,71 PD out patients were reassessed using various scales,including Unified Parkinson Disease Rating Scale,Hoehn-Yahr grade,Mini Mental State Exam,Hamilton Depression Scale and Hamilton Anxiety Scale.Results The incidence of motor complications was 43.6％ (31/71).Logistic regression analysis showed that the prognostic factors for motor fluctuation were age of onset ≤ 54 (OR =6.4,95％ CI 1.7-24.5,P =0.006),the occurrence of swallowing difficulty (OR =3.8,95 ％ CI 1.0-14.1,P =0.04) and depression (OR =4.0,95 ％ CI 1.1-13.7,P =0.03),and the prognostic factors for dyskinesia were age of onset ≤54 (OR =48.5,95％ CI 1.9-121.0,P:0.02),the occurrence of falling (OR =64.1,95％ CI 2.9-142.2,P =0.008) and the daily levodopa dosage ＞ 600 mg(OR =17.5,95％ CI 1.1-276.2,P =0.04).Based on the regression model,the assessment questionnaire for motor complicationsincludes the followings:the questionnaire for motor fluctuations:the age of onset ≤54,2 points; the occurrence of swallowing difficulty,1 point; the occurrence of depression,1 point; the questionnaire for dyskinesia:the onset age ≤54,2 points; the occurrence of falling,3 points; daily levodopa dosage ＞ 600 mg,2 points.In all patients in this study,21.7％ (10/46) was asscssed to a total scorc of 0-1 which is associated with a low risk of motor fluctuation,8/16 had a score of 2 which is associated with intermediate risk and 8/9 got a score of 3-4 associated high risk; 10.2％ (5/49) had a score of 0-2,a low risk of dyskinesia,4/13 had a score of 3-4,a intermediate risk and 7/9 got a score of 5-7 which is associated with a high risk.Conclusions Age onset ≤54,the occurrence of swallowing difficulty,falling and depression,daily levodopa dosage ＞ 600 mg were considered to be the prognostic factors of motor complications in PD.The questionnaire may help to stratify PD patients into low-risk,medium-risk and high-risk groups for motor complications and the higher the score in the questionnaire is related to the higher risk of motor complications.

Objective To investigate the expressions of gonadotropin-releasing hormone receptor(GnRHR)and epidermal growth factor receptor(EGFR) in gastric carcinoma and to explore its clinical significance.Methods The expressions of GnRHR and EGFR in 31 cases of gastric carcinoma were observed by SP immunohistochemical method and the method of in situ quantification.Results The GnRHR and EGFR positive immunoreactive substances were located in the tumor cells of gastric carcinoma,GnRHR 28 cases (90.32％ ),EGFR 15 cases ( 48.39％ ),the expression of GnRHR increased in accordance with histologic differentiation,well-differentiated 14 cases,moderately differentiated 9 cases,poorly differentiated 5 cases,the expression of EGFR decreased in accordance with its increasing degree of histologic differentiation,well-differentiated 3 cases,moderately differentiated 5 cases,poorly differentiated 7 cases,( P ＜ 0.05 ),and GnRHR was more obvious than EGFR in immunoreaction.Conclusion GnRHR and EGFR could be related to the pathogenesis and the development of the gastric carcinoma.

Objective To assess the development,progression and change of nonmotor symptoms in patients with Parkinson' s disease and its impact on patients' quality of life.Methods Eighty-seven consecutive patients with idiopathic Parkinson' s disease were studied.Parkinsonian status was assessed at baseline and 3 years follow-up using Unified Parkinson' s Disease Rating Scale (UPDRS) part Ⅲ & Ⅳ,Nonmotor Symptoms Questionnaire (NMSQuset),Parkinson-related quality of life (PDQ) scales.Paired ttest,Chi-square test,Spearman rank order correlation and hierarchical regression of the major statistical procedures were employed.Results At 3 years follow-up,compared to baseline,the UPDRS Ⅲ score (22.21 ±11.31 vs 30.49± 11.68),UPDRS Ⅳ score(1.00±1.54 vs 2.94±3.12),NMS score (7.98±3.96 vs 12.35 ± 5.12) and PDQ score (28.11 ± 22.88 vs 36.65 ± 26.95) were significantly higher ( t =- 5.54,- 5.75,- 6.46,- 5.29,all P =0.000,respectively).The aggravation of motor and nonmotor symptoms caused the decline of quality of life.The prevalence of constipation,problem of remembenng thing,nocturia ranked tops,and depression,and anxiety were still in the middle,compared with baseline.The prevalence of pains,sweating,dribbling,sense of incomplete emptying etc were significantly increased during the follow-up,△R2 were 21.6％ and 23.4％ respectively,resulting in the deterioration of quality of life.Conclusions PD nonmotor symptoms appear from the early stage.The motor and nonmotor symptoms aggravate over time.

Objective To observe progression of motor symptoms and occurrence of motor complications in parkinsonian patients and investigate the rate of progression of motor symptoms and risk factors of motor complications.Methods One hundred and thirty patients diagnosed with PD in 2007 in Department of Neurology,Xinhua Hospital were followed up for 3 years.The Unified Parkinson' s Disease Rating Scale (UPDRS) and H-Y staging were used to assess and follow up motor symptoms and occurrence of motor complications,and analyze the rate of progression of motor symptoms and risk factors of motor complications with statistics.Results ( 1 ) Mean annual growth in H-Y staging was 2.5％,and UPDRS motor scores was 3.1％ ; the incidence of dysphagia at endpoint in patients was increased by 23.0％ compared with baseline; incidence of falls was increased by 16.7％;(2)Daily levodopa dose at endpoint ( OR =1.004,95％ CI 1.001—1.006,P =0.008 ) was independent risk factors with dyskinesia; While duration ( OR =1.637,95％ CI 1.083—2.473,P =0.019 ),levodopa treatment duration ( OR =0.698,95％ CI 0.494—0.987,P =0.042 ),daily levodopa dose at haseline ( OR =1.005,95％ CI 1.001—1.010,P =0.016) and at endpoint ( OR =1.014,95 ％ CI 1.001 —1.027,P =0.032 ) were risk factors with motor fluctuations.Conclusions As the disease progresses,motor function in parkinsonian patients gradually worsens,the incidence of swallowing difficulty and of falls is increased,and the incidence of motor complications is increased.The total exposure to levodopa in parkinsonian patients is predictor for motor complications.