BACKGROUND:Extracel ular vesicles (EVs) are a kind of subcel ular component produced by paracine mechanism including exosomes, microparticles and microvesicles, which have become hotspots in recent years. OBJECTIVE:To review the research status and progress of EVs, especial y in the studies about definition, secreting mechanism, isolation and identification, biological characteristics and functions in diseases as wel as in biomedical research. METHODS:The first author retrieved PubMed and CNKI databases for relative articles published from July 2006 to August 2016. The keywords were“extracel ular vesicles, exosome, microvesicle, microparticle”in English and Chinese, respectively.RESULTS AND CONCLUSION:A total of 44 eligible literatures are enrol ed. Almost al cel s can secrete EVs, which contain a variety of metrocyte-derived bioactive molecules, such as lipids, proteins, mRNAs, microRNA, lncRNA, cicrRNA, and non-coding RNA. These bioactive molecules are encapsulated in EVs or binding with the membrane. EVs are described to be involved in inflammation, immunity, signal transduction, cel survival and apoptosis, angiogenesis, thrombogenesis, and autophagy, which are of great significance to the maintenance of homeostasis and disease progression. Special EVs may be used as new biomarkers for the diagnosis and prognosis of many diseases and serve as novel tools in the fields of antitumor therapy, regenerative medicine, immunoregulation and vaccination and drug delivery. But the molecular mechanisms regulating the secretion of EVs and the specific pathways activated upon EVs interaction with the target cel are not ful y understood. Based on miRNA, lncRNA and circRNA are attracting researchers’ attention.

Objectives: To study the executive function (EF) profiles in children with ADHD. Methods: 1.We used some neuropsychological tests,including Stroop test, visual and auditory Go/No-Go tasks, digits reciting inverse, delayed spacial position memory span test, tower of London (TOL), tail making test (TMT),to evaluate the capacity of response inhibition, phonological working memory, visual-spacial working memory, planning and set-shifting of subjects. Results: 1.The ADHD children spent more time to accomplish color naming when the word color was inconsistent with the word meaning than normal control (NC) in Stroop test(p﹤0.05). 2.The ADHD children made more errors than NC in both visual and auditory Go/No-Go test(p﹤0.01). 3.The scores of digits reciting inverse was lower in ADHD than NC(p﹤0.01). 4.The representation of ADHD was poorer than NC in delayed spacial position memory span test(p﹤0.01). 5. In TOL test, the ADHD children spent more time in all of two-move, four-move and five-move tasks than NC, and broke rules more frequently than NC(p﹤0.05). 6.In TMT, the ADHD children spent more time and made more errors on part B than NC(p﹤0.05), and there was no significant difference on part A (p﹥0.05). Conclusions: The obvious impaired executive functions are found in children with ADHD, involving poor response inhibition,impaired working memory, dysfunction of planning and set-shifting.

Objective To explore the clinical curative effect of recombinant human endostatin injection combined with chemotherapy in the treatment of patients with advanced gastric cancer and malignant ascites,and its influence on the quality of life.Methods 62 patients with advanced gastric cancer from July 2012 to July 2015,were randomly divided into observation group (31 cases)and control group (31 cases).The control group was treated with FOLFOX6 chemotherapy,the observation group was given recombinant human endostatin injection on the basis of the treatment of the control group.The two groups were treated for 3 weeks.The curative effect,QOL score,Karnofsky score,the change of serum CEA and CA19 -9 levels and drug adverse reaction incidence before and after treatment were compared in the two groups.Results The RR of the observation group was higher than that of the control group (54.84 vs 29.03%,χ2 =4.239 3,P <0.05).The QOL score and Karnofsky score in the two groups were increased after treatment (P <0.05).The QOL score and Karnofsky score after treatment in the observation group were higher than the control group(t =6.512 7,5.669 0,all P <0.05).The serum CEA and CA19 -9 levels of the two groups decreased significantly after treatment (P <0.05).The serum CEA and CA19 -9 levels of the observation group were lower than the control group after treatment (t =5.276 0,6.310 8,all P <0.05).The leukopenia,thrombocytopenia, peripheral neurotoxicity,decreased hemoglobin,diarrhea,nausea and vomiting adverse reaction rate of the two groups had no significant differences (P >0.05).Conclusion The clinical efficacy of recombinant human endostatin injec-tion combined with malignant ascites in the treatment of patients with advanced gastric carcinoma is significant,and can significantly improve the quality of life of patients,has the important research value.

Objective To explore and evaluate the hemostatic effects of hemocoagulase in elderly surgery bleeding. Methods 150 cases (60~75 years old)admitted to Affiliated Hospital of Chuanbei Medical College for abdominal operation from June 2011 to June 2012 were used as subject. They were divided radomly into hemocoagulase group (50 cases),reptilase group (50 cases)and physiological saline solution group (50 cases). The hemostatic time,hemorrhagic volume,hemorrhagic volume per square unit,and body coagulation parameters in three groups were observed and compared. Results The hemorrhagic volume in hemocoagulase group was (9.2 ±2.7 )g,average hemostatic time was (124.5 ±45.7 )s,and hemorrhagic volume per square unit was (0.3 ±0.1 )g,which were similar with reptilase group,but significantly different with those in physiological saline solution group (P<0.05 ). In hemocoagulase and reptilase groups,the hemorrhagic and hemoagglution time decreased in 30 minutes and 1 day after operation, the differences were statistically significant when compared with physiological saline solution group (P <0.05 ).Conclusion Hemocoagulase has better hemostatic effect on hemorrhagic capillary in elderly surgery.

Objective To compare the effect of low concentration versus ultra-low concentration of ropivacaine in combination with sufentanil delivered via programmed intermittent epidural bolus (PIEB) with patient-controlled epidural analgesia (PCEA) during labour on obstetric and anesthetic outcomes.Methods Seventy-six ASA Ⅰ or Ⅱ nulliparous parturients who were at full term with a singleton fetus in vertex presentation were randomized to receive 0.1 ％ ropivacaine with 0.5 μg/mL sufentanil (Group L,38 cases) or 0.06％ ropivacaine with 0.5 μg/mL sufentanil (Group UL,38 cases).Another matched 76 cases of primiparas without labor analgesia (Group C) served as controls.For primiparas received analgesia,an epidural catheter was inserted when the cervical dilatation was up to 2-3 cm.The analgesia level was controlled below T8,and VAS score was controlled below 4.Thirty minutes after analgesia started,Group L and UL received PIEB with PCEA regimen including basal infusion of 8 mL/h of ropivacaine with sufentanil,patient-controlled bolus 6 mL and lockout interval 10 minutes.The duration of labor,delivery mode,Apgar score,VAS score and anesthetic drug consumption of each group were recorded.Results The second stage of labor were not statistically different between Group UL and C.The second stage of Group L was longer than that of Group C (P＜0.05).Furthermore,with similar performance in pain score and satisfactory level at each time point,Group UL consumed much less ropivacaine than Group L (P＜0.05).The cesarean section rate,instrumental delivery rate and the Apgar score were not significantly different among the 3 groups.Conclusions While using PIEB with PCEA,0.06％ ropivacaine was capable of providing satisfactory analgesia effects for primipara and has less effects on the obstetric outcome.Therefore,it could be recommended for labour analgesia.

Objective Investigate the clinicopathological characteristics of h?rthle cell tumors of the thyroid. Methods Sixteen cases of HCT were studied by the clinicopathological study and immunohistochemical and review of the literature. Results There were 13 cases of h?rthle cell adenomas, 5 h?rthle cell follicular carcinomas. Immunostains showed that almost all benign and malignant HCT expressed TG, vimentin, S-100 protein. Conclusions HCT is a potential malignant tumor with a defined pathologic feature. It should be follow up for a longer time to their biological behaviors. To distinguish between the benign and the malignant depends on traditional encapsulation, and whether there is a blood vessel invasion or metastasis.

Objective To compare blood pressure control in community hypertensive patients with different management methods.Methods Two neighborhood committees in a community of Pudong were selected as study area using cluster sampling method.A total of 5 166 residents aged ≥35 y were screened for blood pressure; the subjects with high blood pressure and had antihypertensive medication in last 6 months were included,and patients with secondary hypertension was excluded.The patients who entered community hypertension management program and got medication from community were included in community group; those who did not enter in community management program and/or not get medication from community were included in non-community group.Self-designed questionnaire was used for investigation.The medication compliance,awareness of hypertension risk factors and high blood pressure control were compared between two groups.Results Among 5 166 residents 4 763 were surveyed for hypertension with a response rate of 92.2％ and hypertension prevalence rate of 23.2％ (1 105/4 763).Among 1 012 patients with drug treatment for more than 6 months,there were 878 cases in community (86.8％) and 134 cases (13.2％) in non-community group.There were no significant differences in gender,age,education,working condition between community group and non-community group (P ＞ 0.05).44.3％ (389/878) patients in community group had a history of high blood pressure ＞ 10 y and that was 56.7％ (76/134) in non-community group (P =0.011) ; 28.6％ (251/878) patients in community group were at high risk for risk stratification and that in non-community group was 47.8％ (64/134) (P ＜0.001).The awareness of hypertension risk factors in community group and non-community group was 83.9％ and 95.5％,respectively (P ＜ 0.001).The medication compliance and blood pressure control rates in two groups were 93.2 ％ and 84.3 ％ (P ＜ 0.001),68.6％ and 51.5 ％,respectively (P ＜ 0.001).Conclusion The outcomes of hypertension management in terms of medication compliance and blood pressure control in community group are better than those in non-community group.

Objectives To evaluate the effect of thyroid hormone therapy with low dose of thyroxin on cardiac function in elderly patients with heart failure and sick euthyroid syndrome. Methods Forty-seven patients (33 males and 14 females, mean age 85.9+4.6 years,ranging from 80 to 99 years) with chronic heart failure (NYHA Ⅱ-Ⅳ) and low triiodothyronine (T3) state were randomly allocated to the treatment group or control group. The treatment group patients received oral administration of levothyroxine sodium (Euthyrox) 25-50mg/d in addition to conventional therapy of heart failure, whereas patients in control group were given conventional therapy only. Serum level of total T3 (TT3), free T3 (FT3), total thyroxine (TT4), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were determined. For both groups, left ventricular ejection fraction (LVEF) and stroke volume (SV) were assessed by two-dimensional echocardiography before and at 8 weeks after treatment. The changes of these parameters after the treatment were evaluated by adjusting heart rate in the two groups. Results The reduced serum T3 level in the treatment group was corrected after thyroid hormone therapy,and these patients had a significant improvement in cardiac function after treatment. By contrast, in the control group only changes of serum TT3 and TT4 levels and SV and LVEF after treatment were statistically significant. The heart rate-adjusted mean SV and LVEF in both groups were also increased, which was significantly greater in the treatment group than in the control group. Conclusion In the elderly patients with heart failure and sick euthyroid syndrome, addition of thyroxine at a low dosage to the conventional treatment could effectively improve the low T3 state and cardiac function independent of changes of heart rate.

Objective To assess the MR characterization of coronary microembolization (CME)in an animal model as well as the evolution using MR cardiac cine,first-pass perfusion,and delay enhancement imaging.Methods Coronary microembolization models were established through intracoronary infusion of 120 000 microspheres (42 μm)into the left anterior descending artery in 1 1 pigs. Coronary angiography was performed at baseline and immediately after the injection of microspheres.MR imaging was carried out at baseline,6 hours,and 1 week after microembolization.Then,postmortem evaluation was performed using NBT and HE staining.Re-sults Coronary angiography after the injection of microspheres showed normal-appearing epicardial arteries in all animals.Coronary microembolization caused a significant decline in systolic wall thickening of the microembolized myocardial segments on cine MR ima-ges [from (42.6±2.0)% at baseline to (20.3±2.3)% at 6 hours and (31.5±2.1)% at 1 week after CME;P < 0.001 for both]. First-pass perfusion deficit was visualized at 6 hours after microembolization,and was less pronounced at 1 week.Hyperenhanced myocardium was found on delay enhancement MRI at 6 hours after microembolization in microembolized segments,but was not shown at 1 week. The microinfarcts were detectable microscopically through HE staining but invisible for the naked eye on gross NBT specimen.Con-clusion Coronary microembolization may cause a persistent decline in myocardial contraction and its MR characterization may vary with different stages.A combined use of different cardiac MRI techniques and follow-up examinations may be helpful for evaluating myocardial impairment due to coronary microembolization.

Objective To investigate muscle MRI characteristics of lower limbs in Chinese patients with dysferlinopathy. Methods Detailed clinical information of 42 patients with dysferlinopathy confirmed by Western blot or DYSF genetic test were studied retrospectively, including age, course, serum creatinine kinase (CK) and modified Gardner?Medwin and Walto score, and T1WI, STIR image. Each muscle was scored according to its fatty degeneration evaluated on T1WI (fat replacement score). The patients were divided into 3 groups:Miyoshi myopathy (MM), limb girdle muscle dystrophy 2B (LGMD 2B) and preclinical stage (asymptomatic hyperCKemia or exercise intolerance). The data including the scores of each muscle between MM and LGMD 2B were compared by ANOVA analysis and Chi square test. The relationship of fatty replacement score with course and GM?W score was analyzed by Spearman rank correlation analysis. Results Thirty nine patients underwent thigh MR scanning and 36 patients underwent leg MR scanning. At the thigh level, there is no specificity that the fatty replacement was found in both the anterior and posterior parts while the rectus femoris, sartorius and gracilis were rarely involved. At the leg level, the most severely involved muscle was the soleus, followed by gastrocnemius. It formed a sandwich?like pattern that the anterior part (anterior and posterior tibial muscle and peroneus longus muscle) and the posterior part (medial and lateral gastrocnemius) were less involved than the middle part (soleus). Of 42 patients, 14 cases were MM, and 24 were LGMD 2B. The fat replacement score of each muscle between two groups showed no significant differences (F=0.066 to 3.907,P all>0.05) except for the adductor muscle (F=5.239, P=0.028), semimembranosus (F=6.703, P=0.014) and semitendinosus (F=7.689, P=0.009). Of 4 pre?symptomatic cases, 3 showed edema of posterior part of leg on STIR, especially soleus. In all patients, the fat replacement score correlated positively with course (rs=0.732, P=0.000) and GM-W score (rs=0.485, P=0.001). Conclusions The MRI of Chinese patient with dysferlinopathy was characterized by the milder involvement of rectus femoris, sartorius and gracilis muscle in the thigh and a sandwich?like pattern in the leg, which is helpful for differential diagnosis of inflammatory Myopathy versus other types of muscular dystrophy.