BACKGROUND:Exosomes can be detected in synovial fluid and plasma at levels that vary with the progression of osteoarthritis in patients with osteoarthritis,and may play a relieving role in the local inflammation of osteoarthritis,cartilage calcification,and osteoarthritic joint degradation. OBJECTIVE:To comprehensively understand the function and mechanism of exosomes from different stem cells in the diagnosis and treatment of osteoarthritis,and to present the prospects and challenges of exosome therapy for osteoarthritis. METHODS:We searched the articles published from October 2003 to October 2023 included in PubMed and CNKI databases with the keywords of"exosomes,osteoarthritis,mesenchymal stem cells,stem cells"in Chinese and English,respectively.A total of 99 articles were finally included for review. RESULTS AND CONCLUSION:The appearance of exosomes brings hope to the diagnosis and treatment of osteoarthritis.The differences of RNA,protein,and lipid content in exosomes can be used as biomarkers for the diagnosis of osteoarthritis.At the same time,exosomes from various stem cells can effectively protect chondrocytes,relieve inflammation,maintain cartilage matrix metabolism,and regulate angiogenesis and subchondral bone remodeling,showing excellent potential in the treatment of osteoarthritis.The engineered exosomes break through the traditional limitations and enhance the specificity and efficiency of treatment by modulating the expression of specific non-coding RNA,providing a new strategy for the treatment of osteoarthritis.

Objective To investigate the impact of donor kidney histopathological lesions on the risk of BK virus (BKV) infection and progression after kidney transplantation. Methods A retrospective analysis was conducted on the clinical data of 326 kidney transplant recipients from deceased donors at the Department of Kidney Transplantation, the First Affiliated Hospital of Zhengzhou University, from January 2019 to June 2020. The recipients were divided into two groups based on whether BKV infection occurred after kidney transplantation: the BKV infection group (145 cases) and the non-BKV infection group (181 cases). The correlation between donor kidney histopathological findings from zero-hour biopsy and BKV infection, as well as the impact on the risk and progression of BKV infection, was analyzed. Results The incidence of BKV infection among the 326 kidney transplant recipients was 44.5% (145/326). The clearance rate of BKV after infection was 82.1% (119/145), while 17.9% (26/145) progressed to BKV viremia. Among the 326 qualified kidney biopsy specimens, 32 cases showed mild tubular atrophy, 324 cases had mild acute tubular injury, 27 cases exhibited mild hyaline arteriosclerosis, 10 cases had moderate to severe hyaline arteriosclerosis, 7 cases showed mild interstitial inflammation, 23 cases had mild interstitial fibrosis, 6 cases exhibited mild arterial intimal fibrosis, and 1 case had moderate to severe arterial intimal fibrosis. Multivariate logistic regression analysis revealed that male recipients, donor age and tubular atrophy were independent risk factors for BKV infection (all P<0.05). Tubular atrophy was also an independent risk factor for the progression from BKV uria to BKV viremia (P<0.05). Conclusions Donor kidney histopathological lesions have a certain impact on BKV infection and progression after kidney transplantation. Patients with more severe tubular atrophy in donor kidneys have a higher risk of BKV infection after kidney transplantation and are more likely to progress to BKV viremia.

Objective To analyze the trend of heart disease death and the life expectancy without cause of death in Qidong City, Jiangsu Province from 1990 to 2019, and to provide reference for the prevention and control of heart disease. Methods Data on heart disease deaths among residents in Qidong City from 1990 to 2019 were collected through the Qidong City Death Registration and Monitoring System. The crude mortality rate (CR) and Chinese age-standardized mortality rate (CASR), potential years of life loss (PYLL), average years of life loss (AYLL), potential life loss years rate (PYLLR), life expectancy, and life expectancy without cause of death were calculated, and the annual percentage change (APC) was used to analyze the trend of heart disease death. Using SAS9.2 software, the death trend prediction was conducted by the ARIMA model in time series analysis. Results From 1990 to 2019, 27,762 residents died of heart disease in Qidong City, with a CR of 81.20/100 000 and an APC of 3.734%. There were 12 358 deaths of heart disease in men, with a CR of 73.24/100 000 and an APC of 3.86%, while there were 15 404 deaths of heart disease in women, with a CR of 88.95/100 000 and an APC of 3.63%. CR showed an upward trend (all P < 0.001). The PYLL for heart disease was 66 192.00 person-years, the AYLL was 13.23 person-years, and the PYLLR was 2.16‰. The life expectancy loss from heart disease was gradually increasing: 0.89 years in 1990 to 1.85 years in 2019, with an APC of 0.405% (P<0.001, a statistically significant trend). The prediction results showed that in 2029, the life expectancy after heart disease would reach 88.17 years. Conclusion From 1990 to 2019, the crude mortality rate of heart disease in Qidong City has showed an increasing trend, leading to an increasing loss of life due to heart disease year by year. The mortality rate and life loss of heart disease in women are higher than those in men. Targeted intervention measures should be further adopted to reduce the mortality rate of heart disease among residents in Qidong.

Objective To analyze the correlation between serum miR-939 and miR-15b expression and mi-crovascular injury in patients with diabetic retinopathy(DR).Methods A total of 176 patients with type 2 di-abetes diagnosed and treated in the Baoding Second Hospital from January 2021 to October 2022 were selected as the study objects.The subjects were divided into 74 patients without DR(NDR group),62 patients with non-proliferative DR(NPDR group)and 40 patients with proliferative DR(PDR group)according to whether or not DR occurred and the degree of lesions.Real-time fluorescent quantitative PCR was used to detect the relative expression levels of miR-939 and miR-15b in serum of all groups,the level of vascular endothelial growth factor(VEGF)was detected by enzyme-linked immunosorbent assay,and the count percentage of en-dothelial cells(ECs),endothelial progenitor cells(EPCs)and circulating progenitor cells(CPCs)was detected by flow cytometry.Serum levels of miR-939,miR-15b,VEGF and ECs,EPCs and CPCs were compared in 3 groups.Pearson correlation was used to analyze the correlation between serum miR-939 and miR-15b and VEGF,ECs,EPCs and CPCs.Multivariate Logistic regression was used to analyze the factors affecting the oc-currence of DR in patients with type 2 diabetes.Results The relative expression levels of miR-939 and miR-15b in PDR group and NPDR group were lower than those in NDR group,while the serum VEGF levels were higher than those in NDR group,with statistical significance(P＜0.05).ECs in PDR group and NPDR group were higher than those in NDR group,while EPCs and CPCs were lower than those in NDR group,the differ-ence was statistically significant(P＜0.05).Serum miR-939 was negatively correlated with VEGF and ECs(r=-0.407,-0.613,P＜0.05),and positively correlated with EPCs and CPCs(r=0.481,0.486,P＜0.05).Serum miR-15b was negatively correlated with VEGF and ECs(r=-0.539,-0.625,P＜0.05),and positively correlated with EPCs and CPCs(r=0.451,0.483,P＜0.05).Multivariate Logistic regression anal-ysis showed that the duration of type 2 diabetes,hemoglobin A1c,2-hour postprandial blood glucose,VEGF,miR-939 and miR-15b were the influencing factors for the occurrence of DR in type 2 diabetes patients(P＜0.05).Conclusion The expression of miR-939 and miR-15b in serum of DR patients is closely related to VEGF,ECs,EPCs and CPCs,and the expression of miR-939 and miR-15b in serum of DR patients can provide a certain reference for early judgment and evaluation of the degree of microvascular injury.

At present,mechanical thrombectomy(MT)is the most effective means of achieving vascular recanalization in treating acute ischemic stroke(AIS)caused by large vessel occlusion.However,the monitoring and management of the patient's complications after MT has become a thorny clinical problem and it has attracted wide attention.Being of its non-invasive,flexible and quick diagnosis,and other advantages,the neurosonography has already established a perfect system in the evaluation and monitoring field of cerebral hemodynamic and structural pathology.With the innovation in technology and equipment,the guiding mode for non-invasive monitoring of intracranial pressure,autoregulation of cerebral blood flow,monitoring of intracranial hemorrhage and detection of other space-occupying lesions has been used for AIS patients,which has gradually become an important tool for the postoperative management of MT.This paper aims to make a comprehensive review about the application of neurosonography monitoring technology in AIS patients after MT,so as to provide a basis for the clinical implementation of prospective interventions,to enable AIS patients to obtain the maximum benefits from the postoperative management of MT,and to reduce the mortality of AIS patients.

Objective Establish a standardized evaluation system for medical faults,and provide theoretical basis for medical institutions and related industries to evaluate the illegality of medical behaviors.Methods Based on a litera-ture review,the medical fault assessment system was initially constructed,and then a research group was estab-lished to use Delphi method to invite 31 experts to evaluate the importance and feasibility of each article of the medi-cal fault assessment system and put forward suggestions for modification.Results The effective recovery rates of the two rounds of expert consultation were 83.9％and 96.8％,the expert authority coefficient was 0.902 and 0.887,and the Kendall's W test of all levels differences were statistically significant(P＜0.001).The medical fault assess-ment system finally constructed includes 5 first-level items including practicing medicine according to law,informed notification,diagnosis and treatment technology,medical record documents and hospital management,as well as 10 second-level items,20 third-level items and 47 fourth-level items.The mean values of importance and feasibili-ty scores of all articles were greater than 4,standard deviations were less than 1,and coefficients of variation were less than 0.2.Conclusion The medical fault standardized evaluation system is scientific,reliable,innovative and appli-cable.

Objective Establish a standardized evaluation system for medical faults,and provide theoretical basis for medical institutions and related industries to evaluate the illegality of medical behaviors.Methods Based on a litera-ture review,the medical fault assessment system was initially constructed,and then a research group was estab-lished to use Delphi method to invite 31 experts to evaluate the importance and feasibility of each article of the medi-cal fault assessment system and put forward suggestions for modification.Results The effective recovery rates of the two rounds of expert consultation were 83.9％and 96.8％,the expert authority coefficient was 0.902 and 0.887,and the Kendall's W test of all levels differences were statistically significant(P＜0.001).The medical fault assess-ment system finally constructed includes 5 first-level items including practicing medicine according to law,informed notification,diagnosis and treatment technology,medical record documents and hospital management,as well as 10 second-level items,20 third-level items and 47 fourth-level items.The mean values of importance and feasibili-ty scores of all articles were greater than 4,standard deviations were less than 1,and coefficients of variation were less than 0.2.Conclusion The medical fault standardized evaluation system is scientific,reliable,innovative and appli-cable.

Knee osteoarthritis(KOA)is a degenerative joint disease with a high incidence,which has seriously affected the quality of life of middle-aged and elderly people.Salviae Miltiorrhizae Radix et Rhizoma,a commonly used traditional Chinese medicinal for activating blood and removing stasis,has been proved to have a certain preventive effect on KOA in basic research and clinical application.Studies have found that the active ingredients of Salviae Miltiorrhizae Radix et Rhizoma have a variety of anti-KOA effects,such as regulation of inflammatory factors,anti-oxidative stress,inhibition of chondrocyte apoptosis,regulation of cartilage matrix degradation,and promotion of chondrocyte autophagy.It can reduce joint pain and inflammatory edema,delay articular cartilage degeneration,and maintain cartilage matrix homeostasis.This paper reviews the effect and mechanism of the effective components from Salviae Miltiorrhizae Radix et Rhizoma on the prevention and treatment of KOA,and analyzes the shortcomings of its related research.Our aim is to provide reference for the clinical treatment of KOA.

Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.

Objective To construct a curriculum system for higher vocational education in speech-language-hearing rehabilitation based on the World Health Organization rehabilitation competency framework(RCF),to align with international standards. Methods Based on RCF,curriculum theory and principles of vocational education psychology,a curriculum system and its content for higher vocational education in speech-language-hearing rehabilitation were developed.The curric-ulum content and core competencies were analyzed in detail across four levels:basic courses,specialized basic courses,specialized core courses and practical training courses. Results From the perspective of the seven competency domains of RCF,the theoretical and practical significance of con-structing a speech-language-hearing higher vocational education curriculum system based on RCF was systemati-cally elaborated.The study emphasized the importance of establishing competency-oriented higher vocational re-habilitation education for developing students'professional competence,adapting to job requirements,and pro-moting career development.A curriculum content system for speech-language-hearing rehabilitation higher voca-tional education based on RCF was systematically constructed,encompassing basic courses,professional cours-es,and practical training courses.The course names,main content and competency objectives at each level were analyzed in detail. Conclusion It is important to develop the course system of higher vocational education of speech-language-hearing reha-bilitation based on RCF.By comparing with international standards,the curriculum is optimized,focusing on im-proving students'vocational competence and promoting the international development.The curriculum system covers key areas such as core values,beliefs,practice and professionalism,integrates basic,core and practical training courses to achieve a competence-oriented curriculum system for higher vocational speech-language-hear-ing rehabilitation education.