BACKGROUND:The self-renewal and multi-directional differentiation of pluripotent stem cells possess the potential to revolutionize people's understanding of biology,medicine,development,and disease.Stem cells play an important role in the early stage of embryonic development,and the study of them could be beneficial to understanding of the basic principles of biological development and tissue or organ formation,exploring the potential mechanisms of various diseases,studying the repair and regeneration of damaged tissues or organs,and promoting drug discovery and personalized treatment. OBJECTIVE:To review the research progress of pluripotent stem cells,summarize and categorize the fundamental types of pluripotent stem cells,and elucidate the lineage situations of various types of pluripotent stem cells in common mammals. METHODS:PubMed,Web of Science,CNKI,and WanFang databases were searched systematically,with the keywords"pluripotent stem cells;embryonic stem cells;induced pluripotent stem cells;expanded potential stem cells;livestock pluripotent stem cells"in English and Chinese.The 99 articles related to mammalian pluripotent stem cells were systematically screened according to inclusion and exclusion criteria,and then reviewed. RESULTS AND CONCLUSION:(1)According to classical theory in mouse embryonic stem cell research,the pluripotent state of stem cells is divided into two forms:na?ve and primed.Na?ve state corresponds to the inner cell mass of pre-implantation embryos before attachment to the uterine wall,while primed state corresponds to the epiblast after implantation.These two states exhibit significant differences in epigenetic features,transcriptional activity,external signal dependency,and metabolic phenotype.It is later discovered that there is an intermediate state between na?ve and primed called formative pluripotency.Therefore,the pluripotency of pluripotent stem cells is a continuous developmental process rather than a unique cell state.(2)In addition to obtaining pluripotent stem cells from the inner cell mass,there are various methods and lineages for acquiring pluripotent stem cells,including embryonic germ cells established using primitive germ cells from mouse embryos,induced pluripotent stem cells created by the dedifferentiation of adult mouse and human fibroblasts with four factors—Oct3/4,Sox2,c-Myc,and Klf4;embryonic stem cell-like cell lines cultured from somatic cell nuclear transfer,parthenogenesis,neonatal or adult testicular or ovarian tissue,very small embryonic-like stem cells derived from various adult tissues and expanded pluripotent stem cells derived from pre-implantation stages.These pluripotent stem cells all share the common characteristics of continuous self-renewal,expressing core pluripotency factors and possessing the ability to differentiate into the three primary germ layers.(3)Currently,pluripotent stem cells are being used for disease modeling to study the mechanisms of various diseases and develop new drugs.Simultaneously,scientists are attempting to use pluripotent stem cells to cultivate various tissues and organs,offering new possibilities for regenerative medicine and transplantation.However,the clinical application of pluripotent stem cells faces safety challenges,including issues of cell mutations and immune rejection.Continual improvement in the methods of generating pluripotent stem cells will make them safer and more efficient for clinical applications.(4)Based on the methods of obtaining and lineage establishment of pluripotent stem cells in mice and humans,various types of pluripotent stem cells have been established in livestock,including embryonic stem cells,induced pluripotent stem cells,germ lineages of pluripotent stem cells,and expanded potential stem cells.Research on livestock pluripotent stem cells opens up new avenues for animal reproduction,breeding,genetic engineering,disease modeling,drug screening,and the conservation of endangered wildlife.

Purpose/Significance To deeply analyze the research progress on the application of medical knowledge graph in the field of stroke,to discuss the problems of the development of stroke knowledge graph in China,and to put forward suggestions for the construc-tion of stroke knowledge graph.Method/Process By reviewing and analyzing the relevant literature,the application of medical knowledge graph in the field of stroke is sorted out and summarized.Result/Conclusion There are still many deficiencies in the development of stroke knowledge graph in China,and in the future,in-depth research can be carried out from four aspects,namely,expanding the ap-plication scope of knowledge graph,promoting the fusion of knowledge graph,developing more efficient algorithms,and upgrading to cog-nitive graph by joint artificial intelligence(AI).

OBJECTIVE: To investigate the association between the glucose-to-lymphocyte ratio (GLR) and prognosis of patients with sepsis-associated acute kidney injury (SA-AKI). METHODS: Based on the Medical Information Mart for Intensive Care-IV (MIMIC-IV), SA-AKI patients aged ≥ 18 years were selected. According to the tertiles of GLR, the patients were divided into GLR1 group (GLR ≤ 4.97×10^-9 mmol), GLR2 group (4.97×10^-9 mmol < GLR < 9.75×10^-9 mmol) and GLR3 group (GLR ≥ 9.75×10^-9 mmol). Patients with SA-AKI were divided into survival group and death group according to whether they survived 28 days after admission. The patient's gender, age, vital signs, laboratory test results, comorbidities, sequential organ failure assessment (SOFA), acute physiology score III (APS III) score and treatment measures were extracted from the database. Kaplan-Meier survival analysis was used to make the survival curves of patients with SA-AKI at 28 days, 90 days, 180 days and 1 year. Multivariate Logistic regression analysis model was used to explore the independent risk factors of 28-day mortality in patients with SA-AKI. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive efficacy of GLR for the prognosis of patients with SA-AKI. RESULTS: A total of 1 524 patients with SA-AKI were included, with a median age of 68.28 (58.96, 77.24) years old, including 612 females (40.16%) and 912 males (59.84%). There were 507 patients in the GLR1 group, 509 patients in the GLR2 group and 508 patients in the GLR3 group. There were 1 181 patients in the 28-day survival group and 343 patients in the death group. Grouping according to GLR tertiles showed that with the increase of GLR, the 28-day, 90-day, 180-day and 1-year mortality of SA-AKI patients gradually increased (28-day mortality were 11.64%, 22.00%, 33.86%, respectively; 90-day mortality were 15.98%, 26.72%, 40.55%, respectively; 180-day mortality were 17.16%, 28.29% and 41.73%, and the 1-year mortality were 17.95%, 29.27% and 42.72%, respectively, all P < 0.01). According to 28-day survival status, the GLR of the death group was significantly higher than that of the survival group [×10^-9 mmol: 9.81 (5.75, 20.01) vs. 6.44 (3.64, 10.78), P < 0.01]. Multivariate Logistic regression analysis showed that GLR was an independent risk factor for 28-day mortality in patients with SA-AKI [when GLR was used as a continuous variable: odds ratio (OR) = 1.065, 95% confidence interval (95%CI) was 1.045-1.085, P < 0.001; when GLR was used as a categorical variable, compared with GLR1 group: GLR2 group OR = 1.782, 95%CI was 1.200-2.647, P = 0.004; GLR3 group OR = 2.727, 95%CI was 1.857-4.005, P < 0.001]. ROC curve analysis showed that the area under the ROC curve (AUC) of GLR for predicting 28-day mortality in patients with SA-AKI was 0.674, when the optimal cut-off value was 8.769×10^-9 mmol, the sensitivity was 57.1% and the specificity was 67.1%. The predictive performance was improved when GLR was combined with APS III score and SOFA score, and the AUC was 0.806, the sensitivity was 74.6% and the specificity was 71.4%. CONCLUSIONS GLR is an independent risk factor of 28-day mortality in patients with SA-AKI, and high GLR is associated with poor prognosis in patients with SA-AKI.
Male ; Female ; Humans ; Blood Glucose ; Glucose ; ROC Curve ; Prognosis ; Sepsis/diagnosis* ; Acute Kidney Injury ; Retrospective Studies ; Intensive Care Units

Objective:To explore the impact of coronary CT angiography (CCTA) image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve (CT-FFR).Methods:Based on the CT-FFR CHINA trial, the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA, CT-FFR and FFR measurement. The subjective and objective assessments of CCTA image were performed on a per-vessel level. The objective assessments included the enhancement degree of coronary artery, the signal-to-noise ratio (SNR) of the aortic root. We used χ 2 test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups (non-artifact vs. artifact), enhancement degree of coronary artery groups (≤400 vs. 401-500 vs.>500 HU), SNR of the aortic root groups (≤16.9 vs.>16.9), body mass index (BMI) groups (<25 kg/m 2 vs.≥25 kg/m 2) and heart rate groups (<75 bpm vs.≥75 bpm). FFR and CT-FFR values≤0.80 was identified as myocardial ischemia. Results:The study enrolled 317 patients with 366 vessels. All target vessels in CCTA images were successfully analyzed by CT-FFR. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of the non-artifact group were 90.45%, 86.75%, 93.10%, 90.00%, 90.76% and 0.928, respectively, and those of the artifact group were 83.23%, 87.21%, 79.01%, 81.52%, 85.33% and 0.869, respectively. The differences in accuracy and specificity were statistically significant (χ 2=4.23, P=0.040; χ 2=8.55, P=0.003). The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups (all P>0.05). Conclusions:The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia. The degree of vascular enhancement, SNR, BMI, and heart rate have no significant effect on the diagnostic performance of CT-FFR.

Objective:To investigate the effect of patellar replacement and patellar height on the therapeutic effect of total knee arthroplasty (TKA).Methods:A retrospective analysis was conducted on 429 patients (92 males, 337 females; aged 66.81±7.05 years; left=226, right=203) with severe knee osteoarthritis who underwent TKA in the First Affiliated Hospital of Shandong First Medical University from July 2020 to December 2021, with the body mass index of 27.60±4.22 kg/m 2, Grade-III Kellgren-Lawrence, and Insall-Salvati (IS) ratio >0.8. Afterward, the patients were divided into 4 groups according to whether patellar replacement was performed or not and the preoperative IS ratio (IS of 0.8-1.2 for normal patellar and >1.2 for high patellar): the patellar replacement+normal height patellar group (263 cases), the patellar replacement+high height patellar group (66 cases), the patellar non-replacement+normal height patellar group (68 cases), and the patellar non-replacement+high height patellar group (32 cases). Moreover, postoperative intergroup IS ratio, Knee Society Score (KSS), Hospital for Special Surgery (HSS) knee score, Oxford Knee Score (OKS), knee range of motion, complications, and satisfaction were analyzed. Results:All patients were followed up, and the time was 1.15±0.16 years (range, 1-2 years). Postoperative symptoms such as knee pain, swelling, and limitation of movement were significantly improved compared with the preoperative period. Additionally, KSS pain score, knee range of motion, HSS score and OKS score were significantly different among the four groups ( F=9.49, P<0.001; F=11.09, P<0.001; F=6.74, P<0.001; F=3.24, P=0.022), but the difference in KSS functional scores was not statistically significant ( F=1.84, P=0.140). At the same time, the KSS pain score, HSS score, OKS score, and knee range of motion (41.84±5.25, 80.43±6.99, 14.27±5.39, and 122.33°±4.93°) in the patellar replacement+normal height patella group were all better than those in the patellar non-replacement +normal height patella group (38.31±7.31, 77.00±7.81, 16.05±5.81, 120.99°±4.90°) and patella non-replaced + high height patella group (37.97±7.28, 75.62±11.02, 16.63±6.67, 116.25°±13.08°), with statistically significant differences ( P<0.05). The patella replacement+ high height patella group only had better KSS pain scores than the patella non-replaced+normal height patella group and the patella non-replaced+high height patella group (41.74±6.35, 38.31±7.31, 37.97±7.28), with statistically significant differences ( P<0.05). Moreover, Knee mobility was better in the patellar replacement+high height patella group (121.68°±2.88°) and the patellar non-replacement+normal height patella group (120.99°±4.90°) than in the patellar non-replacement+high height patella group (116.25°±13.08°), and the differences were statistically significant ( P<0.05). There were statistically significant differences in the IS ratio before surgery, 1 day after surgery and 1 year after surgery among the four groups ( P<0.05), and the IS ratio at 1 day after surgery was lower than that before surgery with statistically significant differences ( P<0.05), but there was no statistically significant difference between the IS ratio at 1 year after surgery and that before surgery ( P>0.05).Furthermore, the preoperative differences in the incidence of anterior knee pain, patellar clicking and satisfaction rates in patients with different patellar heights were not statistically significant ( P>0.05). Finally, the patellar replacement group possessed a lower incidence of anterior knee pain (normal height patella: 7.6% vs. 16.2%, χ 2=4.68, P=0.031; high height patella: 9.1% vs. 25.0%, χ 2=4.46, P=0.035) and patellar clicking (normal height patella: 9.1% vs. 17.6%, χ 2=4.05, P=0.044; high patella: 13.6% vs. 31.2%, χ 2=4.28, P=0.039); there was no significant difference in satisfaction rate among the four groups after operation ( P>0.05). Conclusion:Postoperative outcomes were better in patients with patellar replacement during TKA than in patients with no patellar replacement, and knee range of motion was better in patients with normal-height patellas than in patients with high patellas preoperatively, with no effect of TKA on patellar height.

Spinal cord injury (SCI) is a disabling and destructive central nervous system injury that has not yet been successfully treated at this stage. Three-dimensional (3D) bioprinting has become a promising method to produce more biologically complex microstructures, which fabricate living neural constructs with anatomically accurate complex geometries and spatial distributions of neural stem cells, and this is critical in the treatment of SCI. With the development of 3D printing technology and the deepening of research, neural tissue engineering research using different printing methods, bio-inks, and cells to repair SCI has achieved certain results. Although satisfactory results have not yet been achieved, they have provided novel ideas for the clinical treatment of SCI. Considering the potential impact of 3D bioprinting technology on neural studies, this review focuses on 3D bioprinting methods widely used in SCI neural tissue engineering, and the latest technological applications of bioprinting of nerve tissues for the repair of SCI are discussed. In addition to introducing the recent progress, this work also describes the existing limitations and highlights emerging possibilities and future prospects in this field.

Objective:To investigate the effect of bel canto breathing training method on the respiratory rehabilitation of patients with chronic obstructive pulmonary disease in stable stage.Methods:Using a quasi-experimental research method, 40 patients with chronic obstructive pulmonary disease in stable stage from September to December 2018 in two wards (the first ward and the second ward) with the same level of diagnosis and treatment of respiratory physicians, nurses' nursing ability and the ward environment of the First Hospital of Lanzhou University were selected. The first ward was used as the experimental group, and the second ward was used as the control group, there were 20 cases in each group. The patients in the experimental group were given bel canto breathing training and conventional breathing training, while the patients in the control group were given conventional breathing training. A WeChat group was established, and training videos were distributed in the WeChat group after discharge to urge patients to perform training. After 3 months of intervention, the quality of life, anxiety, depression, and pulmonary function were evaluated by St George′s Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS), proportion of forced expiratory volume in forced vital capacity in the first second(FEV1/FVC).Results:The SGRQ score, HADS score and FEV1/FVC value in the experimental group before intervention respectively were (41.35 ± 9.94), (16.55 ± 4.29) points and (47.13 ± 8.85)%, at discharge respectively were (28.95 ± 5.66), (11.20 ± 2.75) points and (59.51 ± 10.49)% and after three months of intervention respectively were (21.75 ± 6.31), (7.15 ± 3.51) points and (66.69 ± 7.87)%, while the SGRQ score, HADS score and FEV1/FVC value in the control group before the intervention respectively were (42.10 ± 10.50), (16.60 ± 4.73) points and (46.23 ± 10.14)%, at discharge respectively were (34.90 ± 10.16), (13.35 ± 2.37) points and (52.91 ± 7.86)%, and after three months of intervention (35.80 ± 7.27), (14.20 ± 5.05) points and (52.65 ± 8.60)%. With the increase of the intervention time of bel canto breathing training, the SGRQ score and HADS score decreased ( F=29.65, 17.44, both P<0.05), and the FEV1/FVC value increased ( F=27.38, P<0.05). Within-group comparisons the SGRQ score, HADS score, and FEV1/FVC value in the experimental group at discharge, three months after the intervention versus pre-intervention, and three months after the intervention versus discharge showed statistically significant differences ( t values were -7.73 - 7.38, all P<0.05). SGRQ score, HADS score, and FEV1/FVC value in the control group were only statistically significant at discharge versus pre-intervention ( t=-4.63, -2.79, 5.28, all P<0.05). The SGRQ, HADS score and FEV1/FVC value between the 2 groups were not statistically significant before the intervention, but statistically significant at discharge and three months after the intervention ( t values were -6.53 - 5.39, all P<0.05). Conclusions:Bel canto breathing training can improve the quality of life, reduce anxiety, depression and increase FEV1/FVC in patients with chronic obstructive pulmonary disease in stable stage.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Biodegradable vascular stents have better biocompatibility than drug-eluting stents. The blood vessels are rebuilt and degraded after normal physiological functions are restored. Due to it will not stay in the body for a long time and the patients don't need taking anti-rejection drugs all the time, it becomes the focus of attention in the treatment of coronary heart disease. This article introduced the development history of biodegradable stents and reviewed the research status of several different materials of vascular stents (animals or humans)
Absorbable Implants ; Animals ; Drug-Eluting Stents ; Humans ; Stents

Objective:To probe the diagnostic performance of the combined evaluation of stenosis and plaque characteristics based on coronary computed tomography angiography (CCTA) in identification of myocardial ischemic lesions, using the invasive coronary angiography (ICA)-based fractional flow reserve (FFR) as the gold standard.Methods:From November 2018 to March 2020, the patients with suspected or known coronary artery disease and scheduled for ICA at 5 clinical trials centers were enrolled in this study. All the patients underwent CCTA, ICA and FFR in turn in one week. The luminal stenosis and plaque characteristics were measured and assessed including plaque burden, volume ratios of calcification and non-calcification, lesion length and CT vulnerable features. All culprit vessels were divided into FFR≤0.8 and FFR>0.8 groups, and the parameters of plaque characteristics were compared. The correlation of ischemic lesions with CCTA stenosis and plaque characteristics was analyzed by the logistic regression analysis. The ROC curve was used to evaluate the sensitivity and specificity of CCTA stenosis rate and plaque characteristics, meanwhile the area under curve (AUC) of each parameter was compared by Delong test.Results:Three hundred and sixty-six culprit vessels in 317 patients were analyzed in this study (169 vessels in ischemia group and 197 in nonischemia group). The plaque burden [34.3% (30.3%, 38.8%) vs. 32.4% (28.5%, 37.9%); Z=-2.622, P=0.009], proportion of CT vulnerable features [26.9% (45/169) vs.11.7% (23/197); χ 2=15.311, P<0.001] and lesion length [22.1 (14.4, 35.0) mm vs. 17.6 (11.0, 26.0) mm; Z=-4.388, P<0.001] in FFR≤0.8 group were higher than those in FFR>0.8 group. The results of logistic regression analysis revealed that CCTA stenosis, lesion length, and CT vulnerable features were significant predictors for myocardial ischemia (OR values: 3.794, 2.461, 1.027; P<0.001, P=0.002, P=0.002). The diagnostic performance of CCTA ≥50% stenosis alone in identification of ischemic lesions was low (AUC=0.625). When it combined high-risk plaque characteristics and lesion length, the AUC was improved to 0.714 with a statistical significance. Conclusions:CCTA stenosis, lesion length, and CT vulnerable features are major predictors in identification of myocardial ischemic lesions, and the combination will significantly improve the diagnostic performance of CCTA ≥50% stenosis.