Exosomes contain many components including variety kinds of lipids,proteins,microRNAs (miRNAs) and so on.They can transport their loaded substances to the recipient cells and play a role of biology.Exosomal miRNAs play important roles in the occurrence and development of tumors,and they are closely related to the tumor growth,metastasis,drug resistance and immune regulation.Exosomes and exosomal miRNAs can be served as reference indexes for tumor metastasis and prognosis,which provide new targets for tumor therapy.

Objective To investigate the effects of comprehensive psychological intervention on psychological and biochemical indexes of servicemen in three degree combat readiness. Methods 189 servicemen in three degree combat readiness were randomly divided into the study group and the control group by squad. Beyond the same exercise and education as the control group, the study group received the comprehensive psychological intervention in the course. They were all assessed with Self-rating Depression Scale (SDS) ,self-rating anxiety scale (SAS) ,and simplified coping style questionnaire (SCSQ) at the day entering three degree combat readiness (prereadiness) and the next day after the mission (post-readiness). The serum concentrations of superoxide dismutase ( SOD), malondialdehyde ( MDA), cortisol ( COR), and aldosterone (ALD) were determined to evaluate biochemical indexes at the same time. Results Compared with the control group after the combat readiness, the total scores of SDS( (42.1 ± 9.3 ) vs (49.2 ± 10.3 ) ) and SAS( (43.8 ± 7.2) vs (50.6 ± 10.2), P＜ 0. 01 ) were lower, the score of the positive coping style ( ( 21.2 ± 6.4) vs ( 18.2 ± 5.4), P ＜ 0. 05 ) was higher in the study group.Meanwhile,the levels of MDA( (2.6 ±0.51 ) μmol/L) ,COR( (252.5 ±52.4) ng/ml) ,and ALD ( (97.5 ±24.4) pg/ml) were lower ( P ＜ 0. 01 ), the activity of SOD ( ( 1551 ± 354 ) U/gHb) was higher ( P ＜ 0. 01 ) after the combat readiness. In the control group post-readiness, the total scores of SDS (49.2 ± 10.3) and SAS (50.6± 10.2) ,the levels of MDA ( (2.9 ±0.35 ) μmol/L) ,COR( (333.8 ±62.6) ng/ml) ,and ALD( ( 123.8 ±29.6)pg/ml ) increased significantly (P＜0.01), the score of the positive coping style ( 18.2 ± 5.4) and the activity of SOD ( 1302 ± 352 ) U/gHb decreased significantly ( P ＜ 0. 01 ). The total scores of SDS, SAS were negatively related to the level of SOD ( r= -0. 142, -0. 119, P＜0. 0lor 0.05) ,and positively related to COR ( r=0. 156,0. 159, P＜0. 01 ) and ALD ( r=0.151,0.156, P＜0. 01 ). The score of positive coping style was positively related to the level of SOD ( r=0. 141, P＜0. 01 ) ,and negatively related to COR and ALD ( r= -0. 152, -0. 155, P＜ 0. 01 ). Conclusion Comprehensive psychological intervention could effectively improve the psychological and biochemical indexes,reduce the stress level of servicemen in three degree combat readiness.

Objective To identify the metabolic alterations in the prefrontal lobe in male patients with schizophrenia by proton magnetic resonance spectroscopy (~1H-MRS), and to study the relationship between metabolic alterations and executive function. Methods The study was conducted in 26 male schizophrenics with medicine-free for at least 7 days and 28 normal controls. A multi-voxel ~1H-MRS on the prefrontal lobe was performed in all the subjects within 24 hours of admission. Wisconsin Card Sorting Test (WCST) was used to evaluate executive function. The NAA, Cho and Cr were measured and the ratios of NAA/Cr, Cho/Cr and NAA/(Cho+Cr) were calculated. Results Compared with normal controls, the patients demonstrated significantly lower NAA/Cr ratio (t=2.93, P<0.01) in the left prefrontal lobe and poorer performance in WCST (P<0.05). The NAA/Cr ratio in the left prefrontal lobe was positively associated with the responses errors and the perseverative errors of WCST(r=0.45, P＜0.05; r=0.47, P＜0.05)and negatively associated with the categories completed and conceptual level responses(r=-0.54, P＜0.01; r=-0.56, P＜0.01). Conclusions Abnormalities in neuronal function and/or integrity are present in the left prefrontal lobe of male schizophrenics. The neuron damage in the left prefrontal lobe of male schizophrenic may be the primary cause of cognition dysfunction.

Objective To assess the efficacy and safety of combining rociverine tablets with Suoquan cap-sules in the treatment of female patients with overactive bladder(OAB).Methods 152 female patients with OAB were randomly divided into three groups.Patients in rociverine group were administered rociverine tablets 10mg three times a day for 4 weeks.Patients in Suoquan capsule group were administered Suoquan capsules 1.8g three times a day for 4 weeks.Patients in combination group were administered rociverine tablets 10mg and Suoquan capsule 1.8g three times a day for 4 weeks.Each group of patients had to complete 3d voiding diary before and after treatment to record daily frequency of micturition,urgency,urgency incontinence,nocturia and avoiding volumes,OABSS score and drug side effects were also observed.All the data were analyzed to assess the efficacy and safety of treatment.Results There were significant differences in daily frequency of micturition,urgency,urgency incontinence,nocturia,avoiding volumes and OABSS score of patients in each group before and after treatment(all P <0.01 ).Moreover,compared with combination group,rociverine and Suoquan capsule group all had significant differences(F =41.765,53.834, 25.304,37.867,214.791,73.486,all P <0.01 ).There was no significant differences between rociverine and Suoquan capsule group(all P >0.05).The incidence rates of adverse events of rociverine and combination group were 7.8% and 22.6%,respectively,there was significant difference between the two groups(χ2 =4.372,P =0.032). Conclusion Combining rociverine tablets with Suoquan capsules in the treatment of female patients with OAB was effective and safe.

Objective To identify the metabolite levels in prefrontal lobe and thalamus in patients of schizophrenia with proton magnetic resonance spectroscopy (1H-MRS). Methods Twenty-six schizophrenics with medicine-free for at least 7 d and 28 normal controls were assessed in this study. All subjects underwent examination of multi-voxel 1H-MRS on prefrontal lobe and thalamus within 24 h. The NAA, Cho and Cr were measured and the ratios of NAA/Cr, Cho/Cr and NAA/(Cho+Cr) were determined. Results Compared with the controls, the NAA/Cr ratio of schizophrenics was significantly lower in left prefrontal lobe and bilateral thalamus (all P＜0.05). No statistical difference of NAA/(Cho+Cr) ratio and the Cho/Cr ratio was found between two groups. Conclusion Abnormalities in neuronal function and/or integrity are present at left prefrontal lobe and bilateral thalamus simultaneously in schizophrenics.

ObjectiveTo explore the state of misdiagnosis, missed diagnosis and excesseive diagnosis related to cerebral palsy(CP).Methods389 cases were retrospectively analyzed who were misdiagnosed, missed or escessively diagnosed related to CP as the first diagnosis in the inpatient and outpatient department from July 1999 to March 2010.ResultsAmong 389 cases, 156 cases were missed or misdiagnosed as nutritional disease, and 118 cases of other diseases were misdiagnosed as CP, while 115 cases who were normal children was excessively diagnosed as CP. The false diagnosis had relativity with children's age: doctors are more prone to make misdiagonsis when the children's age are smaller, while 293 cases were misdiagnosed before 12 months old (75.3%); 102 cases (65.4%) were misdiagnosed or missed as other diseases before September, 2004, while 87 cases (75.7%) were excessively diagnosed as CP after September, 2004. Frequency of misdiagnosis as CP reduced from 2004, and the proportion dropped from 55.9% to 44.1%.ConclusionIt is very important to master the diagnostic standard of CP. Both sides of the question are important, one side is to make early diagnosis and early treatment in order to achieve the best effect of rehabilitation, and the other side is to prevent misdiagnosis and excessive diagnosis which woud delay illness, or waste medical resources, increase the financial and psychological burden.

Aim To investigate the effect of curcumin against high-fat-diet induced C57BL/6J mice bone changes and the correlation between the expression of cathepsin K and curcumin.Methods Curcumin treated C57BL/6J mice had been on high fat diet for 12 weeks.The HE, Alizarin red S staining and Safranin O/fast green staining of femur were employed to evaluate bone microstructure, bone metabolism and bone development.The expressions of cathepsin K were assessed by Western blot and immunohistochemical staining.Results Histopathological results showed that curcumin could improve the destruction of trabecular bone structure, cartilage development and bone calcification.Biomechanical results proved that curcumin could improve the bone strength of the type 2 diabetic mice induced by high fat.The results of immunohistochemistry and Western blot assay indicated that curcumin could significantly inhibit the expression of cathepsin K in bone tissues of mice.Conclusion Curcumin can increase bone strength, improve bone microstructure, and enhance the degree of bone calcification, which may be achieved by inhibiting the expression of cathepsin K.

Objective:To analyze the situation of doctoral enrollment work in Peking Union Medical College Hospital after the change of enrollment mode from "unified enrollment examination" to "application-assessment" system, and summarize the enrollment work.Methods:The information of candidates in two different enrollment methods of the unified enrollment examination in 2016 and the application-assessment system in 2017 and 2018 was collected and compared. The opinions of doctoral candidates in 2018 on the application-assessment system were collected by questionnaires. Excel 2016 was used to input data for descriptive statistical analysis and SPSS 20.0 was used to analyze the quantitative data by chi-square tested and t-tested.Results:Since 2016, the total number of candidates applying for Peking Union Medical College Hospital has shown a downward trend, and the age of candidates has shown a trend towards younger age. However, there was no statistical difference in candidate's gender, source of students, and their Master's Graduation Schools. Only among the 2017 and 2018 academic degree candidates, there was a statistical difference in scores between the freshman and the previous student ( P=0.025). The results of the questionnaire showed that students were highly satisfied with "application-audit" system of Peking Union Medical College Hospital (82.54%, 52/63). More than 90.00% of the students agreed with the evaluation indexes. Additionally, 85.71%(54/63) of students suggested that professional and academic types use different enrollment evaluation indicators, which could fully reflect the quality of professionalism and the training potential of cultivation. Conclusion:The change of enrollment model from "unified admission examination" to "application-audit" system has little impact on the candidates of Peking Union Medical College Hospital. In the process of implementing the "application-assessment" system, the Educational Management Department of Peking Union Medical College Hospital has actively explored the system construction and standardization process, and supervised the whole enrollment process, which has gained the trust and recognition of candidates as well as high student satisfaction.

Objective:To recognize the overall situation of the core competency of medical professional postgraduate, analyze the advantages and disadvantages of the training process, and provide basis for better optimization and revision of training objectives and training plans.Methods:An anonymous online questionnaire was conducted among 264 postgraduates majoring in clinical medicine to recognize the cognition and self-evaluation of core competence, and analyze the differences in scores of different grades and types. SPSS 23.0 was used for independent-samples t test; and one-way analysis of variance to analyze categorical variables. Results:The doctoral degree students' core competency results were higher than those of master degree students, and those of the senior students were higher than junior students ( P<0.05). "System Improvement Ability" [master degree students (2.94±1.07), first-year students (2.82±0.97)], "Patient Management" [(first-year students (2.77±1.22)], "Academic Research" [first-year students (2.90±1.03)], and 4 other indicators were the weakness of students (all less than 3 scores). Conclusion:The students have a good sense of professional identity for doctors. The different depth of the clinical practice education is the possible cause which brings about the differences among students with different degrees. We should focus on strengthening the training for the "shortcomings" in the core competence of students.

Objective: To analyze the computed tomography(CT) features and clinical outcomes of renal epithelioid angiomyolipoma(EAML). Methods: From January 2004 to June 2015, 17 patients with EAML in the Second People′s Hospital of Lianyungang and Nanjing Drum Tower Hospital were included in the study.All patients underwent CT examination.The patients' general data, imaging characteristics and pathologic features were determined by chart review. Results: Nine patients underwent radical nephrectomy, and 8 patients underwent partial nephrectomy.The mean maximal tumor diameter was 6.1 cm (ranged 1.2-12.5 cm). The fat component of one lesion was detected by CT.On unenhanced CT, the intratumoral attenuations were hyperattenuating in 9 patients, isoattenuating in 1 patient and hypoattenuating in 7 patients.The contrast enhancement degree was mild in 1 patient, moderate in 6 patients and marked in 10 patients.The contrast enhancement pattern was homogeneous in 8 lesions and heterogeneous in 9 lesions.All patients were positive for melanoma(12 cases were positive for HMB-45, 3 cases were positive for melan A, and 2 cases were positive for both). The mean follow-up period was 28.5 months (ranged 2-126 months), and 15 patients were alive with no evidence of disease at the time of the last follow-up, 1 patient exhibited local recurrence and lung metastases, and another 1 patient developed distant metastasis. Conclusion Renal EAML has a range of imaging appearances.Our data suggested that the majority of the tumors (size 10 cm) were solid and had a tendency to be hyperattenuating on unenhanced CT images.Hemorrhaging or necrosis was observed in tumors with sizes≥10cm with heterogeneous enhancement.In contrast to classic AML, which is benign, EAML is potentially malignant and exhibits aggressive clinical features, including local recurrence and distant metastasis.