Exosomes are small membrane vesicles secreted into the extracellular medium by a broad array of cells in culture.Exosome proteic and lipid composition is unique and might shed some light into exosome biogenesis and functions.Exosomes secreted from professional antigen-presenting cells(i.e.dendritic cells) and tumor cells are enriched in MHC class Ⅰ and Ⅱ complexes,costimulatory molecules,Hsp70-90 chaperones and tumor antigen,and have therefore been more extensively studied for their immunomodulatory capacities in vitro and in vivo.In this review,we will describle the definition and composition of exsomes and the main biological features pertaining to tumor or DC-derived exosomes,and will also present the early clinical results and limitation of their implementation in cancer immunotherapy.

Objective To evaluate the effects of early and late tracbeostomy on patients with acute severe cerebral trauma.Methods In the retrospective study,167 patients with severe brain trauma ( GCS ＜ 9 ) requiring prolonged mechanical ventilation ( MV ) were managed by percutaneous dilational tracheostomy (PDT) from May 2001 to December 2010.According to the transoral incubation MV duration,the patients were divided into the early tracheostomy (ET) group ( MV duration≤7 d,81 cases)and late tracheostomy (LT) group (MV duration ＞ 7 d,86 cases).The basic clinical characteristics,pre-and post-PDT MV period,total MV duration,length of post-PDT ICU stay,length of ICU stay,length of hospital stay and mortality were compared between the two groups.Results The two groups showed no statistical differences in aspects of age,sex,acute physiology and chronic health evaluation Ⅱ (A-PACHE Ⅱ ) score,GCS,trauma index and craniotomy rate (P＞0.05).Compared with LT group,ET group significantly shortened the pre-PDT MV period [ (5.16 ± 1.33 ) d∶ ( 1 1.64 ± 4.25 ) d,P ＜ 0.01 ],post-PDT MV period ( median:15.0 d∶ 17.0 d,P ＜ 0.05 ),total MV duration ( median:18.0 d∶26.0 d,P＜0.05),length of post-PDT ICU stay (median:16.0 d∶21.0 d,P＜0.01 ) and length of ICU stay (median:21.0 d∶32.0 d,P ＜0.01 ).But the two groups had no statistical differences concerning the length of hospital stay ( P ＞ 0.05 ),ICU mortality ( 17％ ∶ 14％,P ＞ 0.05 ) and in-hospital mortality (25％∶28.4％,P ＞0.05).Kaplan-Meier curves showed that the frequency of MV and ICU stay rate within 60 days in ET group were significantly lower than those in LT group.Conclusions For patients with severe brain trauma,early tracheostomy shortens the duration of MV and length of ICU stay without affecting their prognosis.Thereby,tracheostomy can be performed at early stage when managing acute severe brain injury.

Adult ; Gamma Rays ; Humans ; Male ; Radiation Protection ; instrumentation ; Space Suits

Objective To compare the complication and long-term efficacy of standard and extended pancreaticoduodenectomy for carcinoma of the head of pancreas by meta-analysis.Methods A literature search was performed of PubMed,Web of Science,Springer,WanFang,CNKI and CBMDisc databases from January 1990 to August 2014.Qualitative analysis of these literatures was conducted using Jadad evaluation.Patients with pancreatic head carcinoma undergoing extended radical resection and standard radical resection were divided into treatment group (extended pancreaticoduodenectomy group,EPD) and control group (standard pancreaticoduodenectomy group,SPD),respectively.Based on the heterogeneity test,meta-analysis of a fixed-or random-effect model were used.Results A total of 5 studies suitable for the selection criteria were chosen,involving 597 patients (299 in EPDs and 298 in SPDs).The results of meta-analysis showed that the EPDs have significantly longer operative time (MD =64.36,95％ CI =23.88-104.85,P =0.002) and more dissected lymph nodes (MD =16.45,95％ CI =9.61-23.29,P ＜ 0.000 01) than SPDs.There was no statistical difference (OR =1.76,95 ％ CI =0.66-4.65,P =0.26) in postoperative complications (46.3％ vs 36.0％) mortality (OR =1.31,95％ CI =0.47-3.69,P =0.61),1-year survival rate (OR =0.70,95 ％ CI =0.49-0.99,P =0.05),3-year survival rate (OR =0.79,95％ CI =0.55-1.15,P =0.22),and 5-year survival rate (OR =-0.02,95％ CI =-0.17-0.12,P =0.77).Conclusions Compared with standard radical resection,extended radical resection for pancreatic head carcinoma does not prolong the postoperative 1-,3-,and 5-year survival rates with comparable postoperative mortality and morbidity and prolonged operative time.

Background and qurpose:Docetaxel is one of the most effective chemotherapeutic agents developed in the past few years and has been used for the treatment of various cancers including lung cancer. Drug resistance to docetaxel is one of the main factors accounting for the failure of chemotherapy. This study was done to establish a human lung adenocarcinoma cell line SPC-A1 with the characterization of docetaxel resistance, to investigate its biological mechanism of drug resistance and how to reverse the resistance. Methods:A docetaxel resistant human lung adenocarcinoma cell line SPC-A1/Docetaxel was induced by continuously exposing human lung adenocarcinoma cell line SPC-A1 to gradually increasing doses of docetaxel. The multidrug resistance of SPC-A1/Docetaxel was evaluated by MTT assay. The distribution of cell cycle and rhodamine 123 accumulation in the two cell lines were detected by flow cytometry. Growth fraction was calculated by cytometry, and differentiation of genetics between drug resistance cell line and its parent cell line was analyzed by karyotype analysis.Results:Index number of drug resistance (IR) of SPC-A1/Docetaxel were 13.20, 2.18,1.12,1.39,1.38,0.93, 10.14 and 2.12 to docetaxel, paclitaxel, pharmorubicin, cisplatin,carboplatin, gemzar, vinorelbine and etoposide , respectively. Flow cytometry analysis showed G1/G0 arrest in SPC-A1/Docetaxel cell lines and there was no difference in terms of G2 cell proportion between SPC-A1/Docetaxel and SPC-A1 cell lines. Rhodamine concentration in SPC-A1/Docetaxel cells were markedly lower than that in SPC-A1 cells(806.34?0.49 Vs. 1382.26?0.32). Cell doubling time of SPC-A1/Docetaxel cells and SPC-A1 cells were 35.1 and 27.4 hours, respectively, with no difference in terms of genetics between the two cell lines.Conclusions:The SPC-A1/Docetaxel cell line showed high resistance to docetaxel, and had the characteristic of multidrug resistance. The cell line could be useful for the study of drug resistant mechanism and its reversal of docetaxel.

Objective To systematically review the effectiveness and safety of transcutaneous electricalnerve stimulation (TENS) on symptomatic diabetic neuropathy (DNP). Methods Electronic databases such asPUBMED, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese Biomedical Database weresearched by using such mesh and text keywords as "TENS" and "diabetic neuropathy". Randomized controlled trials(RCTs) on the effect of TENS on symptomatic diabetic neuropathy were included. Studies were selected and availa-ble data was extracted independently by two reviewers. Meta-analysis was performed using RevMan 4.2.8 software.Results Three RCTs involving 78 patients were included in this study. Compared with sham-stimulation, TENStherapy significantly reduced the score in pain (SMD -2.35, 95% CI [-4.24, -0.46 ] ) and the score in numb-ness (WMD -0.18, 95% CI [-0.32, -0.05 ] ). Subgroup analysis shows that TENS therapy was associated with a significant reduction in the score of pain in both 4-week treatment duration ( SMD - 5.37, 95% CI [ - 6.97,- 3.77 ] ) and 6-week treatment duration ( SMD - 1.01, 95% CI [ - 2.01, - 0.01 ] ), but not 12-week treatmentduration (SMD - 1.65, 95% CI [ -4.02, 0.73 ] ). Conclusion TENS therapy is a promising and safe strategyfor treatment of symptomatic diabetic neuropathy. More studies are still warranted to accumulate the evidence of theeffect of TENS therapy on DNP.

Objective To study the clinical effect of total parathyroidectomy with subcutaneous autotransplantation (TPTX + AT) in the treatment of secondary hyperparathyroidism(SHPT) in patients with chronic renal failure.Methods One hundred and thirty-four patients undergoing TPTX + AT in our hospital from January 2013 to October 2014 were includud in this study.The preoperative,postoperative and follow-up intact parathyroid hormone (iPTH),serum calcium,serum phosphorus and calcium-phosphorus product were statistically analyzed.The Kidney Disease Quality of Life Short Form (KDQOL-SFTM) scale was used to evaluate quality of life before and one year after parathyroidectomy.Postoperative complications and recurrence were observed.Results Postoperative iPTH,serum calcium,serum phosphorus and calciumphosphorus product decreased significantly compared with that before surgery.The difference had statistical significance (all P ＜ 0.05).One patient died in perioperative period.Temporary injury of recurrent laryngeal nerve was found in eight patients.Early postoperative hypocalcemia was frequently seen in 124 patients (92.5％) and in 7 cases (5.2％) occured intractable hypocalcemia.The quality of life was significantly improved one year after parathyroidectomy.Recurrence developed in 5 patients after operation.Conclusions TPTX + AT is safe and effective in the treatment of SHPT in patients with chronic renal failure and can significantly improve the patient's quality of life.

Objective This study was performed to investigate the levels of HSP70 in tissue in pemphigus as a possible new theoretical basis for further elucidate the pathogenesis of pemphigus.Methods The expression of HSP70 in 62 patients with pemphigus was determined by immunohistochemistry,and the normal skin was taken as control.Results The results showed that the positive cells of HSP70＞75 ％ in the blisters of pemphigus vulgaris and the positive cells of HSP70＞50％ in the inflammatory cells near the blisters,and the expression of HSP70 was significantly higher than that in normal skin,which was statistically significant(Z=5.42,4.73,P＜0.01).Conclusion The abnormal expression of HSP70 in inflammatory cells and psoriasis of pemphigus patients showed that HSP70 is involved in the pemphigus.

Objective To investigate the clinical features and pathogenic genes of a familial hypokalemic periodic paralysis ( HOKPP).Methods PCR amplification and DNA sequencing were used to screen candidate genes of the HOKPP family members (CACNA1S, SCN4A, KCNE3), and the clinical features were carefully analyzed at the same time.Results The sequencing analyses of the SCN4A gene in the proband identified three nucleotide sequence mutations, which influenced the amino acid sequence of the skeletal sodium channel.One of the mutations was identified as a C/T heterozygous pattern at the 2111th nucleotide position in exon 13, resulting in a change from Thr to Met at the 704th amino acid position of the sodium channel protein.All affected patients carried the Thr704Met mutation, whereas unaffected family members did not.Clinical symptoms in this family followed an autosomal dominant inheritance pattern.Muscles weakness, pain and hypokalemia in the period between attacks were seen in all patients.Paralytic symptoms occurred early, lasted longer and recurred frequently, while cold was the main predisposing factor.With the progress of the disease, patients represented persistent weakness and atrophy in proximal muscles.Conclusions Mutation (Thr704Met) in the SCN4A gene should be responsible for this family.This mutation causes severe HOKPP and progressive muscle atrophy.

Objective To quantitatively detect circulating DNA levels in the plasma of patients withcervical lesion and to determine the value for diagnosis of cervical lesion and cervical cancer . Methods Preoperative blood samples were collected from 53 cases of low-grade lesions, 49 cases of high-grade lesions, 44 cases of cervical invasive cancer and 70 cases of healthy women. Plasma DNA was extracted by magnetic bead method (BILATEST DNA kit). The quantity of plasma DNA was determined by duplex real-time quantitative PCR. Results Median plasma DNA level of invasive cervical cancer patients was 61. 59 mg/L (32. 06 - 162. 16 mg/L) , which was significantly higher than that of healthy women [16. 35 mg/L(11. 98 -22.71 mg/L), P < 0.01]. Among invasive cervical cancer patients, median plasma DNA level of squamous carcinoma patients was slightly higher than that of adenocarcinoma (50. 43 versus 47. 31 mg/L,P>0. 05). Median plasma DNA level of stage I patients was lower than that of stage Ⅱ- Ⅲ patients (46. 02 versus 71. 35 mg/L, P <0. 05). Conclusion Quantitatively detecting plasma circulating DNA may be with some application prospect in the diagnosis of cervical diseases.