Exosomes are nanosized membrane microvesicles secreted by various living cells.They contain proteins,lipids,RNA,and a variety of other biological macromolecules.Exosomes play an important role in many pathological and physiological processes,such as antigen presentation in the immune system,repair of damaged tissues,and growth and migration of tumors.Tumor-derived or tumor-associated exosomes play a vital role in regulating the occurrence and development of tumors.The analysis and detection of exosomes in tumors is helpful for the early diagnosis of tumors and provide new treatment methods.This article reviews exosomes' origin,composition,and functions in the development,migration,diagnosis,and treatment of tumors and provides new ideas for the treatment of tumors.

Objective:To investigate the effect of fibrinogenase combined with aspirin on blood viscosity and clinical efficacy in patients with acute cerebral infarction.Methods:Senventy patients with mild to moderate acute cerebral infarction from October 2016 to June 2020 were collected from the Third People′s Hospital of Dalian. Patients were divided into control group and treatment group according to the random number table method, with 35 cases in each group. The control group was given oral aspirin plus an intravenous drip of normal saline equal to the treatment group, while the treatment group was given aspirin plus fibrinogenase by intravenous drip. Both groups were given symptomatic treatment such as management of blood glucose, blood pressure, arteriosclerosis plaque stabilization and improvement of circulation for 10 d. Blood viscosity and neurological deficit score were measured before and after treatment.Results:Compared with baseline values, WBV showed a slight decrease in all shear rates in the control group after treatment compared with that before treatment, but the difference was not statistically significant ( P>0.05). In the treatment group, all shear rates decreased compared with that before treatment ( P<0.05), and the effect of WBV was significant compared with that of the control group ( P<0.05). The improvement of neurological function in the treatment group was better than that in the control group. The significant efficiency and the total effective rate in the treatment group were significantly higher than those in the control group: 34.3% (12/35) vs. 25.7% (9/35), 88.6% (31/35) vs.71.4% (25/35). Conclusions:Fibrinogenase combined with aspirin in the treatment of acute cerebral infarction patients can safely and effectively reduce blood viscosity and improve clinical symptoms.

AIM: To explore the characteristic of relaxation of porcine cornea after LASIKMETHODS: Usual LASIK was performed on fresh porcine corneas with stable intraoculer pressure (IOP) maintained through optic nerve irrigation. The ablation depth on stroma is 30%, 50% and 70% respectively. Then the dumbbell-shaped corneal strip specimens were cut and stored in 20% Human Albumin solution for use (4℃).Sip up the Albumin solution on specimens, and fixed them on homemade jig. Stress relaxation tests were erformed on Tytron250 Dynamics Experiment System. the loading speed was 385mm/min,extending ratewas 1.5, and relaxation time was 1 000s. The data werecollected electronically and automatically.RESULTS: In LASIK procedure, though a single flap-cutting can cause a little reduction of corneal stress relaxation (P＜0.05,P=0.49), the cornea may still remain its property of visco-elasticity. When ablation depth was 30% or more, corneal stress relaxation decreased to almost one half (P＜0.01).The change of corneal stress relaxation degree in vertical meridian specimen was lower than that in horizontal specimen, especially when ablation depth was 70%, and it's statistically significant (P＜0.001). In LASIK operation, the more depth the ablation, the more reduce the stress relaxation degree, and it's easy to cause deformation and creep deformation.CONCLUSION: The changes of the stress relaxation in verticai and longitudinal meridian specimens are similar, and slightly obvious in longitudinal specimen, especially in 70%ablation group.

OBJECTIVETo study the residue of in roots of Atractylodes macrocephalal and in soil.

METHODSamples were extracted with methanol. The extracts were cleaned up by liquid-liquid extraction and detected by HPLC.

RESULTRepeatability and accuracy of the method was verified by fortified recovery at 0.01, 0.05, 0.1, 0.2 mg x kg(-1) levels. Average recovery were 86.1%-98.3% and RSD were 1.0%-6.5% in root and soil. A. macrocephala was treated with two dosage of carbendazim during growing. Results of field test showed that the half lives of carbendazim were 6.51-7.98 d in cultivated soil, 4.51-6.50 d in roots, separately. After sample was preliminarily processed, the residue of dried samples was 0.042-0.433 mg x kg(-1), higher than the fresh samples.

CONCLUSIONIf 0.2 mg x kg(-1) is recommended as the MRL (maximum residues limited) of carbendazim in the roots of A. macrocephala, it is suggested that the dose of 0.675 kg a.i. x hm(-1) carbendazim is sprayed twice a year, and carbendazim should not be used within 21 days before the harvest.

Agriculture ; methods ; Atractylodes ; chemistry ; drug effects ; Benzimidazoles ; analysis ; pharmacology ; Carbamates ; analysis ; pharmacology ; Drug Residues ; analysis ; pharmacology ; Fungicides, Industrial ; analysis ; pharmacology ; Plant Roots ; chemistry ; drug effects ; Quality Control ; Soil ; analysis

Objective To compare the safely between 3 ways of inserting the anteroinferior iliac spine channel screws using computer simulation.Methods The spiral pelvic CT data of 100 patients were collected who had sought medical treatment at General Hospital of The Northern Theater Command from October 2017 to October 2018.They were 61 males and 39 females,aged from 20 to 60 years (average,47.5 years).The data were imported into Mimics (Materi-alise,Belgium) software to create three-dimensional models of the pelvis.The pelvic modeling data were then imported into 3-Matic (Materi-alise,Belgium) software for post-processing.Three cylinders with a diameter of 6.7 mm were created,taking the anteroinferior iliac spine as the entry point and taking the posterosuperior iliac spine,the posteroinferior iliac spine and the midpoint between the 2 spines as the 3 exit points.The insertion of anteroinferior iliac spine channel screws was simulated to observe the screw penetration.Results In the channel from the anteroinferior iliac spine to the posterosuperior iliac spine,penetration occurred in 41 cases out of the medial ilium and in 2 cases out of the lateral ilium,giving a penetration rate of 43％ (43/100);in the channel from the anteroinferior iliac spine to the midpoint between the 2 spines,penetration occurred in 16 cases out of the medial ilium and in 2 cases out of the lateral ilium,giving a penetration rate of 18％ (18/100);in the channel from the anteroinferior iliac spine to the posteroinferior iliac spine,penetration occurred in 6 cases out of the medial ilium,in 2 cases out of the lateral ilium,in 60 cases out of the greater sciatic notch and in 8 cases out of both the medial ilium and greater sciatic notch,giving a penetration rate of 76％ (76/100).There were significant differences between the 3 ways of insertion in the screw penetration (x2 =68.219,P ＜ 0.001).The rate of screw penetration in the channel from the anteroinferior iliac spine to the posteroinferior iliac spine was significantly higher than that in the channel from the anteroinferior iliac spine to the posterosuperior iliac spine which was significantly higher than that in the channel from the anteroinferior iliac spine to the midpoint between the 2 spines (P ＜ 0.05).Conclusions The channel from the anteroinferior iliac spine to the midpoint between the posterosuperior iliac spine and the posteroinferior iliac spine may lead to a lower rate of screw penetration while the channel from the anteroinferior iliac spine to the posteroinferior iliac spine may lead to a higher rate of screw penetration.

Objective To observe the outcomes of living donor liver transplantation (LDLT) for children with biliary atresia (BA) and to summarize the clinical experiences. Methods Forty-four BA patients (26 boys and 18 girls) underwent LDLT between October 2006 and December 2010. Mean (SD) and median (range) age at operation was (12.1 ± 9.0) months and 9 (6-60) months,respectively. The 44 donors were lineal relatives to the consorted recipients. Their mean (SD) and median (range) age at operation was (32. 7 ± 8. 0) months and 31 (20～54) years, respectively. All donor graft types were the left lateral segments with compatible ABO blood groups. Clinical data,including pre-operative evaluations, surgical technique, postoperative management and outcomes in all donors and recipients were retrospectively analyzed. Results All donors were followed up for (17. 5 ± 13. 3) months. No donor mortality was encountered, with a minimal morbidity and no long-term sequelae. Nine out of 44 recipients died. Three patients died of portal vein thrombosis (PVT), one of hepatic artery thrombosis (HAT), two of biliary complications, one of surgical site infections, one of abdominal bleeding and one of pulmonary infection. The overall 1-year and 2-year cumulative survival rate in recipients was 81. 2% and 76. 1 %, respectively. No re-transplantation was done. Postoperative complications included PVT, HAT, biliary leakage and refluxing cholangitis, pulmonary infections,surgical site infections and acute rejection. Conclusion LDLT has been the effective treatment for pediatric recipients with BA and provides favorable prognosis. To improve prognosis of recipients, the key points are pre-operative evaluations, surgical technique, and postoperative management

Objective To characterize the clinical course of biliary complications after right lobe living donor liver transplantation (RL-LDLT) and to identify the independent risk factors for biliary strictures.Methods 105 consecutive RL-LDLT recipients operated from April 2007 to April 2010 were followed up. The clinical and operative data were reviewed. The biliary complications and independent risk factors of biliary stricture were studied.Results The median follow-up duration was 49.5 months ranging from 562 to 1675 days.A total of 40 patients (38.1 ％) experienced 11 bile leak episodes (10.4％ ) and 37 (35.2％) biliary stricture episodes after transplantation.Bile leaks occurred at a median time of 9 days ranging from 4 to 54 days after transplantation.For biliary strictures,the occurring time was delayed and scattered wide with a median of 7.6 months ranging from 12 to 790 days after transplantation. Moreover, the biliary stricture incidence in the first year after transplantation was significantly higher than later.The independent risk factors for biliary strictures were CMV infection,bile leaks and bile duct size (≤3 mm).Conclusion The independent risk factors for biliary strictures after RL-LDLT were CMV infection,bile leaks and bile duct size (≤3mm).In order to avoid biliary complications,careful preoperative evaluations are necessary. The dissection of bile ducts should be meticulous to protect its blood supply.CMV infection should be prevented after transplantation.Close surveillance of biliary complications should be given to RL-LDLT recipients during the first year after transplantation.

Objective: o explore the problems encountered in the application of GBZ/T 237-2011 edition of "Diagnosis of Chronic Obstructive Pulmonary Disease Caused by Occupational Stimulating Chemicals" , and to provide reference for the revision of the new standard. Methods: Delphi expert survey method was used to consult experts on the reasonableness of six primary indicators (scope of application, diagnostic principles, diagnostic indicators, treatment principles, diagnostic grading, appendix A) and their corresponding secondary indicators in the Diagnosis of Chronic Obstructive Pulmonary Disease (COPD) caused by Occupational Stimulant Chemicals. Results: The results of the first round of Delphi method showed that the reasonable mean of the diagnostic criteria about long-term occupational history, smoking history and clinical diagnostic criteria was less than 7, and the coefficient of variation was greater than 0.25, indicating that the experts disagreed with the scope of application of the original criteria; the average of smoking history and 3-year working age were 1.78 and 3.43 (less than 7) respectively, which indicated that the experts agreed that the two diagnostic indexes were not conducive to the practical work of occupational disease clinicians; among the diagnostic indicators, smoking history and smoking volume were taken into account in a comprehensive way, and the average values were 7.61 and 7.61 (greater than 7) , respectively. the coefficient of variation was less than 0.25, indicating that the experts had concentrated their opinions and agreed that such indicators could be considered into the diagnostic index system. Conclusion "Diagnosis of Chronic Obstructive Pulmonary Disease Caused by Occupational Stimulating Chemicals" should be improved by expanding the scope of occupational irritant gases. Smoking problems can be considered in combination with clinical practice, and occupational exposure history can be considered to reduce appropriately.

Objective To investigate the early clinical efficacy of Masquelet membrane induction technique in the treatment of traumatic long bone defects.Methods A retrospective case series study was conducted to analyze the clinical data of 41 patients with traumatic long bone defects admitted to the General Hospital of the Northern Theater Command from January 2012 to April 2017.There were 36 males and five females,aged 15-70 years,with an average of 38.2 years.There were 20 patients with bone defect at the femur,19 at the tibia,one at the fibula,and one at the ulna.All patients received staged treatment using the Masquelet membrane induction technique.In stage Ⅰ surgery,thorough debridement was first performed,and the secretions were taken for bacterial culture.The average bone defect length after debridement was 6.9 cm (2.0-18.5 cm).The bone defect was filled with antibiotic bone cement to induce the biofilm formation.If the postoperative bacterial culture showed positive results,debridement surgery was performed again.Stage Ⅱ surgery was performed after 6-12 weeks.The white blood cell count,C-reactive protein (CRP),procalcitonin (PCT),erythrocyte sedimentation rate (ESR) were measured before the operation.During the operation,bone biopsy was performed,and the bone cement placeholder was completely removed.The autologous cancellous bone and artificial bone were implanted in the bone defect areas,and the induced membrane was sutured.The healing time of bone defects was recorded,and the Paley fracture healing scoring criteria were used to evaluate the limb function.The complications were observed.The inflammatory markers were reviewed at the last follow-up.Results All patients were followed up for 7-36 months with an average of 13.6 months.A total of 37 patients obtained bone healing.The fracture healing rate of stage Ⅰ was 90％,and the healing time was 6-13 months,with an average of 9 months.According to the Paley fracture healing scoring criteria,the results were excellent in 25 patients,good in 10,and fair in two patients,with the excellent and good rate of 85％.In terms of complications,one patient with superficial infection recovered after dressing change,three patients had deep infection,of which one patient was treated with amputation and two received other treatments,and three patients were treated with membrane induction again because of bone resorption.At the last follow-up,there were significant differences between preoperative and postoperative White blood cell count,CRP,PCT and ESR(P ＜ 0.05).Conclusion For traumatic long bone defects,Masquelet membrane induction technique can promote fracture healing,restore limb function and reduce complications.

As one of the main forms of the medical alliance, the specialty alliance functions as a service carrier for hierarchical medical service and resources integration in the region. The authors introduced the exploration and practice of the West China Women′s and Children′s Alliance, the first pediatric specialty alliance in Sichuan, established by the West China Second Hospital of Sichuan University. Based on family doctor contracted services, the West China Women′s and Children′s Alliance took such measures as differentiated functional positioning, assessment of certified physicians, continuous online quality control, construction of referral platforms, and innovative payment mechanisms. Such efforts effectively integrated the three stages of pre-hospital " preventive care" , in-hospital " disease diagnosis and treatment" , and post-hospital " follow-up management" , exploring the homogenization of medical services within the alliance, and forming a pediatric closed-loop health management system, hence improving the primary medical services.