Exosomes are vesicles with a lipid bilayer structure that carry various active substances, such as proteins, DNA, non-coding RNA, and nucleic acids; these participate in the immune response, tissue formation, and cell communication. Owing to their low immunogenicity, exosomes play a key role in regulating the skeletal immune environment. Macrophages are important immune cells that swallow various cellular and tissue fragments. M1-like and M2-like macrophages differentiate to play pro-inflammatory, anti-inflammatory, and repair roles following stimulation. In recent years, the increase in the population base and the aging of the population have led to a gradual rise in orthopedic diseases, placing a heavy burden on the social medical system and making it urgent to find effective solutions. Macrophages and their exosomes have been demonstrated to be closely associated with the pathogenesis and prognosis of orthopedic diseases. An in-depth understanding of their mechanisms of action and the interaction between them will be helpful for the future clinical treatment of orthopedic diseases. This review focuses on the mechanisms of action, diagnosis, and treatment of orthopedic diseases involving macrophages and their exosomes, including fracture healing, diabetic bone damage, osteosarcoma, and rheumatoid arthritis. In addition, we discuss the prospects and major challenges faced by macrophages and their exosomes in clinical practice.
目的 运用长短期记忆网络(LSTM)模型对郑州市手足口病(HFMD)的发病情况进行预测,为手足口病的防疫工作提供理论指导.方法 利用SPSS 26.0软件对HFMD发病数据和气象数据进行Spearman相关性分析,选取相关性较高的影响因素.使用Python 3.9软件建立LSTM神经网络.以2010年至2018年郑州市HFMD逐月发病数作为训练集,以2019年的发病数据作为测试集,建立6种LSTM模型.结果 加入气象因素与经济因素均能提高模型的预测精度,该模型在2019年测试集的平均绝对误差为231.92,均方根误差为273.54,均优于其他类型LSTM模型,并优于常用的差分整合移动平均自回归(ARIMA)模型.结论 在LSTM模型中加入气象因素与经济因素能够提高预测精度,为HFMD的防控工作做出指导.
卵巢癌是女性生殖系统常见的恶性肿瘤之一,病死率高,预后极差,严重影响患者的生活质量.卵巢癌患者预后的影响因素包括遗传因素、环境因素、临床因素和社会因素等,其中,卵巢癌预后可能与社会经济状态(包括收入、教育和职业等)紧密相关.本文对社会经济状态与卵巢癌预后的关系进行综述,旨在为明确二者间的关系及卵巢癌预后影响因素提供参考.
目的 分析78例非全身型幼年特发性关节炎(JIA)患儿的临床特点,为儿童JIA临床诊治提供依据.方法 收集2013年1月至2020年1月中国医科大学附属盛京医院小儿风湿免疫科住院治疗的78例初诊非全身型JIA病例资料,包括一般情况、实验室检查及治疗等,并对其临床特点进行分析.结果 78例患儿中,男女比例为0.66︰1,少关节型JIA 10例,多关节型JIA 45例,与附着点炎症相关的关节炎23例.少关节型JIA患儿多为幼儿期发病,炎症指标(C反应蛋白及红细胞沉降率)可无明显升高.多关节型JIA多为学龄前期和学龄期发病,与附着点炎症相关的JIA患儿多为青春前期和青春期发病,二者炎症指标均有明显升高,前者可有贫血表现.大部分患儿关节症状为关节活动障碍(59.0％),其次为关节肿胀(33.3％).影像学常见表现为关节积液(71.8％)及滑膜增生(79.5％),同时,30.8％的患儿有骨质破坏.55例(70.5％)患儿初诊时即使用生物制剂治疗,多关节型JIA及与附着点炎症相关的JIA患儿使用生物制剂较未使用患儿的关节活动障碍好转时间明显缩短(P<0.05).结论 不同类型JIA患儿的一般情况、关节症状及炎症指标等临床特点存在差异.应用生物制剂可缩短部分患儿关节活动障碍好转时间.
目的 探讨丰富环境下多重任务导向机器人训练对脑卒中患者步行功能和日常生活活动能力的干预效果.方法 选取接受康复治疗的脑卒中患者59例,随机分为对照组(采用常规康复训练,30例)和研究组(在常规康复训练的基础上增加丰富环境下多重任务导向机器人辅助步行训练,29例),比较治疗前后2组患者Fugl-Meyer运动功能评定量表下肢部分(FMA-LE)评分、Hoffer步行能力分级、Berg平衡量表(BBS)评分、改良Barthel指数(MBI)、表面肌电图信号.结果 治疗前,2组患者FMA-LE评分、Hoffer步行能力分级、BBS评分、MBI、表面肌电图信号的差异均无统计学意义(P>0.05),治疗4周后.2组患者FMA-LE评分、Hof-fer步行能力分级、BBS评分、MBI、表面肌电图信号均较治疗前明显改善(P<0.05),且研究组改善情况好于对照组(P<0.05).结论 丰富环境下多重任务导向机器人辅助步行训练可以改善脑卒中患者步行功能,提高步行能力,增强日常生活活动能力.
目的 探讨miR-23b-5p靶向下调纤维连接蛋白1(FN1)对支气管哮喘(简称哮喘)气道重塑的影响.方法 将BALB/c小鼠随机分为正常对照组和哮喘组,每组6只.Masson染色观察气道壁周围胶原沉积水平.ELISA测定白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)、血管内皮生长因子(VEGF)水平.实时荧光定量PCR(qRT-PCR)检测肺组织中miR-23b-5p表达水平.免疫组织化学染色、Western blotting检测FN1、α-平滑肌肌动蛋白(α-SMA)在肺组织中的表达.TargetScan网站预测miR-23b-5p靶基因,双荧光素酶报告实验验证.转染miR-23b-5p模拟物和抑制剂于人支气管平滑肌细胞(HBSMC)后,Western blotting检测FN1表达水平.结果 与正常对照组相比,哮喘组小鼠气道上皮下胶原沉积,IL-6、TNF-α、TGF-β1、VEGF表达显著增高(P<0.001),miR-23b-5p表达显著降低(P<0.05).免疫组织化学染色、Western blotting结果显示,FN1、α-SMA在哮喘组小鼠肺组织中的表达显著升高(P<0.05).FN1受miR-23b-5p靶向调控,并且与miR-NC组相比,转染miR-23b-5p模拟物后FN1表达水平显著下调(P<0.05),而转染miR-23b-5p抑制剂后FN1表达水平显著升高(P<0.01).结论 miR-23b-5p可通过靶向下调FN1,缓解哮喘气道重塑.
目的 构建一种基于适配体W3和量子点(QD)的探针W3-QD,实现胃癌细胞系和临床胃癌组织的靶向成像.方法 通过流式细胞术检测核酸适配体W3与SGC-7901细胞的结合情况;采用生物素-链霉亲和素的交联方法,将核酸适配体W3与QD偶联形成W3-QD,利用荧光染色观察W3-QD探针对胃癌细胞SGC-7901以及混合细胞中SGC-7901的成像情况;分别采用FAM-W3和QD-W3对SGC-7901细胞进行成像,结果显示QD探针具有更高的灵敏度和光稳定性;构建荷瘤裸鼠模型探究W3-QD探针对体内肿瘤细胞的靶向成像情况;收集临床胃癌组织样本,通过组织石蜡切片及荧光染色证明W3-QD探针对胃癌组织具有特异性识别能力.结果 W3-QD探针能够对胃癌细胞SGC-7901进行特异性成像,且在人类正常胃黏膜上皮细胞GES-1存在的情况下,仍然能够在混合细胞中特异性识别胃癌细胞SGC-7901.与FAM-W3探针相比,W3-QD探针表现出良好的抗漂白性、稳定性和灵敏性.W3-QD对胃癌细胞和组织有良好的特异性.结论 将核酸适配体W3与QD结合能够实现胃癌的靶向成像,可作为一种胃癌早期诊断的工具.
目的 比较静脉自控镇痛与硬膜外自控镇痛在经尿道膀胱肿瘤切除术(TURBT)后的镇痛效果.方法 选取2020年1月至2022年6月于我院泌尿外科行TURBT的60例患者为研究对象,术后30例患者接受静脉自控镇痛,30例患者接受硬膜外自控镇痛.比较2组患者在术后4 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)时间点的静息状态下视觉模拟评分法(R-VAS)疼痛评分、运动状态下视觉模拟评分法(M-VAS)疼痛评分、Ramsay镇静评分,以及术后镇痛指标(术后镇痛药物追加次数、按压镇痛泵次数和有效按压次数)、术后康复指标(首次排气时间、首次下床时间和住院满意度)、并发症发生率(恶心呕吐、呼吸抑制、皮肤瘙痒、膀胱刺激征、心动过缓)的差异.结果 2组患者术后T1～T4时间点R-VAS疼痛评分和M-VAS疼痛评分均逐渐下降(P<0.05);各时间点2组比较,R-VAS疼痛评分、M-VAS疼痛评分、Ramsay镇静评分均无统计学差异(P>0.05).2组比较,术后镇痛指标、术后康复指标和并发症发生率均未见统计学差异(P>0.05).结论 静脉自控镇痛与硬膜外自控镇痛在TURBT后均有良好的镇痛效果,2种镇痛方式在术后镇痛效果以及并发症方面无显著差异.
目的 探讨肺腺癌免疫微环境特征基因以及相关基因对患者生存时间及免疫检查点抑制剂(ICB)疗效的预测价值.方法 使用非负矩阵分解(NMF)聚类分析在癌症基因图谱(TCGA)数据库肺腺癌患者测序数据集(TCGA-LUAD)中鉴定不同的免疫亚型,并对免疫亚型进行肿瘤纯度评估、免疫应答评分(TIDE评分)、肿瘤突变负荷(TMB)分析以及基因组DNA拷贝数变异(CNV)分析.对GSE136961数据集和TCGA-LUAD数据集中的基因表达进行加权基因共表达网络分析(WGCNA).使用R语言中ClusterProfiler包对获得的基因进行基因本体论(GO)富集分析和京都基因与基因组数据库(KEGG)通路分析;利用Cytoscape的regulon模块进行转录调控网络分析;使用SPSS 25.0统计软件绘制Kaplan-Meier曲线进行生存分析.结果 TCGA-LUAD数据集中鉴定出C1、C22种免疫亚型.2种免疫亚型中,C2免疫亚型的免疫应答评分显著高于C1免疫亚型(P<0.05);C2免疫亚型TIDE评分、TMB低于C1免疫亚型(均P<0.05).对GSE136961数据集和TCGA-LUAD数据集进行WGCNA分析共获得10种与免疫耐受以及生存相关的基因.GO富集分析和KEGG通路分析结果显示10种基因主要与DNA损伤以及细胞周期通路相关.转录调控网络分析结果显示E2F4是与免疫耐受相关5个基因(BRCA1、BRCA2、FOXM1、MELK、TUBB)的转录调控因子.2种免疫亚型中进行E2F4及与免疫耐受相关5种基因的表达及生存分析结果显示,E2F4、BRCA1、BRCA2、FOXM1、MELK、TUBB在免疫活性低以及免疫应答差的C1亚型显著高表达.结论 转录调控因子E2F4及与免疫耐受相关5个基因(BRCA1、BRCA2、FOXM1、MELK、TUBB)高表达预测肺腺癌患者具有较短的生存时间和较差的免疫疗效.
目的 探讨鼻内镜下鼻窦球囊扩张术治疗慢性额窦炎的有效性及安全性.方法 回顾性分析行鼻窦球囊扩张术的21例(42侧额窦)慢性额窦炎患者的临床资料,并将患者分为慢性鼻窦炎伴鼻息肉(CRSwNP)组和慢性鼻窦炎不伴鼻息肉(CRSsNP)组,对2组术前及术后2、6、12周各项观察指标进行比较.结果 所有患者术中均成功开放额窦.术后2、6及12周时CRSsNP组额窦口直径改善率分别为37.50％、43.75％、62.50％,CRSwNP组额窦口直径改善率分别为46.15％、30.77％、53.84％,总改善率为42.86％、35.71％、57.14％,2组改善率无统计学差异(P>0.05).2组术后2、6、12周Lund-Kennedy内镜黏膜形态评分均较术前降低,与术前比较差异有统计学意义(P<0.05),2组评分无统计学差异(P>0.05).所有患者均无额窦口膜闭、眼眶青肿、大出血及脑脊液鼻漏等并发症发生,随访期间无患者需再次修正手术.结论 鼻窦球囊扩张术作为功能性内镜鼻窦手术的补充技术具有有效、准确、微创等优势,适于临床应用.
心肌致密化不全又称海绵状心肌病,大部分患儿以左心室心肌致密化不全(LVNC)为主.LVNC是一种与基因及遗传有关的心肌发育异常性疾病,突出的肌小梁和深陷的隐窝为其主要病理改变.随着临床医学的发展,LVNC的诊断率逐渐增加,由于该病预后较差,在临床上也逐渐受到关注.日前,临床以超声心动图影像学表现作为诊断的主要手段,具体诊断还应结合患儿的临床特征.LVNC的治疗以对症治疗为主,主要目标为改善心肌质量,提高患儿生活质量.本文针对LVNC的临床特征、诊断方法、目前可行的治疗手段及不同患者预后情况进行综述,旨在对LVNC的诊治及预后提供参考.
胃肠道间质肿瘤(GIST)是罕见的间质来源的肿瘤.基因突变在GIST发病机制中起着关键作用,靶向治疗已成为GIST的主要辅助治疗手段.通过对酪氨酸激酶抑制剂(TKI)类药物耐药机制信号通路的深入研究,将其中一些分子作为治疗靶点,推动TKI类药物的更新迭代,也为GIST患者提供了更多治疗方法的选择,使部分GIST患者的生存期和生活质量获得显著改善.本文对GIST的发病机制及靶向治疗的研究进展进行综述.
目的 分析原发性浆细胞白血病(pPCL)的临床特点、治疗和预后,以提高对该疾病的认识.方法 回顾性分析2009年5月至2022年1月中国医科大学附属第一医院收治的33例pPCL患者的临床资料,分析其临床表现、实验室相关检查、治疗手段及预后.结果 33例患者中,以乏力为最常见的首发症状,分型以IgGλ型最多见.同时表达CD38和CD138的患者占90.9％(20/22),复杂核型占70.6％(12/17).19例患者接受化疗,1例行自体造血干细胞移植,总体缓解比例为9/19(47.4％).结论 恶性浆细胞疾病pPCL对常规传统化疗不敏感.蛋白酶体抑制剂和免疫调节剂组成的联合方案是目前较成熟的化疗方法,巩固治疗推荐造血干细胞移植.CAR-T、CD38单抗、Bcl-2抑制剂等新的治疗方式为患者带来新的生机.
Nuclear paraspeckle assembly transcript 1（NEAT1） is a recently discovered long non-coding RNA（lncRNA） that is transcribed from multiple endocrine tumor typeⅠtranscriptional sites. NEAT1 has been found to be involved in regulating the growth,migration,invasion,and metastasis of tumor cells to drive the occurrence and development of tumors. It plays an important role in the pathogenesis of many diseases,especially malignant tumors,and is a novel diagnostic biomarker and therapeutic target. This article reviews the progress of research into NEAT1 in gynecology and obstetrics diseases,systematically analyzing the role of NEAT1 in disease occurrence and development,in order to provide new directions for pathogenesis research and potential therapeutic targets for diseases in gynecology and obstetrics.
Objective miR-218-3p regulates lung adenocarcinoma proliferation and immune cell infiltration by targeting signal transducer and activator of transcription 1（STAT1）. Methods The University of Alabama at Birmingham Cancer（UALCAN） data analysis portal was used to analyze the expression level of miR-218-3p in lung adenocarcinoma. CCK8 assay was used to detect the effect of miR-218-3p on the proliferation activity of lung cancer cells,and Western blotting was used to analyze the regulatory effect of miR-218-3p on STAT1. Dual-luciferase reporter detection was performed to analyze the binding of miR-218-3p to the 3’-untranslated region（UTR） of STAT1. The Tumor Immune Estimation Resource（TIMER） database was used to analyze the correlation between STAT1 and lung cancer immune infiltration level. Results The database analysis showed that miR-218-3p was significantly down-regulated in lung cancer. miR-218-3p significantly inhibited proliferation and could negatively regulate STAT1 protein expression level by directly binding to its 3’UTR（P ＜ 0.05）. STAT1 was positively correlated with the infiltration of T lymphocytes,neutrophils,and dendritic cells in lung cancer（P ＜ 0.05）.Conclusion miR-218-3p regulates lung adenocarcinoma proliferation and immune cell infiltration by directly targeting STAT1,thereby participating in the progression of lung cancer.
Objective A computer-aided artificial intelligence diagnosis model based on the X-ray periapical film was created to help dentists effectively diagnose cracked teeth. Methods A total of 182 periapical radiographs were reviewed. Seventy-seven cases were diagnosed with cracked teeth,while the remaining 105 cases were undiagnosed. Imaging features were extracted from the periapical radiographs using Python programming,and features were selected using the Lasso algorithm to develop a machine learning model that identifies a cracked tooth. Results Three high-dimensional texture features were selected. The area under the curve（AUC）,specificity,and sensitivity of the machine learning model on the test set were 0.805,0.727,and 0.815,respectively. Conclusion The machine learning model based on periapical radiographs is effective in diagnosing cracked teeth.
Airway inflammation is the basic pathological feature of asthma（short for bronchial asthma）,which is mainly characterized by the increase,exudation,and infiltration of inflammatory cells and cytokines in the bronchus,as well as edema of the bronchial mucosa and increase in airway secretion. The airway inflammation mechanism in asthma is related to abnormal immune response,including the immune imbalance of helper T（Th） cell type 1（Th1）/Th2 and Th17/regulatory T（Treg） cell. This paper systematically expounds on the immune imbalance mechanism in airway inflammatory injury in asthma to provide theoretical basis for its diagnosis and treatment in the future.
Objective To retrospectively observe the clinical efficacy and safety of short-term high cervical spinal cord stimulation for treating acute or subacute herpes zoster neuralgia in the mandibular branch of the trigeminal nerve. Methods In total,11 patients diagnosed with acute or subacute herpes zoster neuralgia in the mandibular branch of the trigeminal nerve treated with short-term high cervical spinal cord stimulation were recruited. The therapeutic effects were evaluated using a numeric rating scale（NRS）,the dosage of pregabalin,the Pittsburgh sleep quality index（PSQI）,and a 12-item short-form health survey questionnaire（SF-12） before the treatment and at 1,4,12,and 24 weeks follow-ups after treatment. Complications were also recorded. Results The NRS,the dosage of pregabalin,and PSQI at 1,4,12,and 24 weeks after treatment were significantly decreased compared with their pre-treatment baseline（P ＜ 0.01）. The PCS and MCS of SF-12 significantly improved from before the treatment（P ＜ 0.01）. No serious complication was observed during the treatment. Conclusion Short-term high cervical spinal cord stimulation provided significant pain relief for patients with acute or subacute herpes zoster neuralgia in the mandibular branch of the trigeminal nerve. It can effectively reduce the dosage of analgesics and improve the quality of sleep and life of patients. The methods can be safely and effectively used in clinical practice.
Objective To investigate the clinical effect of intermittent pneumatic compression（IPC） combined with neuromuscular electrical stimulation（NMES） on the prevention of lower extremity deep vein thrombosis（DVT） after hip arthroplasty. Methods Overall,126patients who underwent hip arthroplasty were divided into the NMES+IPC group（n = 41）,NMES group（n = 43）,and IPC group（n = 42） according to the postoperative preventive measures used. The coagulation indices,hemorheological indices,blood flow,and incidence of DVT in the three groups were compared. Results Compared with the NMES and IPC groups,the postoperative prothrombin time,active partial prothrombin time,and femoral vein blood flow velocity were significantly higher in NMES+IPC group. Furthermore,the levels of D-dimer and fibrinogen,erythrocyte sedimentation rate,hematocrit,and the incidence of DVT were significantly lower in the NMES+IPC group than in the other groups（P ＜ 0.05）. Conclusion NMES combined with IPC can increase the blood flow velocity in the lower limb,improve coagulation and hemorheological indices,and significantly reduce the incidence of DVT.
Objective To explore the differentially expressed genes（DEGs） of hypertrophic cardiomyopathy using bioinformatics based on the Gene Expression Omnibus（GEO） database and provide new ideas for improving treatment for hypertrophic cardiomyopathy.Methods Patients with hypertrophic cardiomyopathy and normal controls were screened from the GSE68316 and GSE148602 datasets.The DEGs in the datasets were screened using the criteria |log2FC| ≥ 1 and P ＜ 0.05 through the RStudio software and GEO database gene expression analysis tool（GEO2R）. Both were selected to draw heat maps. Key DEGs were analyzed through complete gene ontology（GO） and Kyoto Encyclopedia of Genes and Genomes（KEGG） using R language. Results A total of 247 DEGs were screened from the GSE68316 dataset,including 125 upregulated and 122 downregulated DEGs,while 157 DEGs were screened from GSE148602 dataset,including 44 upregulated and 113 downregulated DEGs. Multiple pathways were enriched in the KEGG and GO analysis.Conclusion The bioinformatics method can effectively explore the DEGs of hypertrophic cardiomyopathy,which may provide a new strategy for the treatment of hypertrophic cardiomyopathy.
