BACKGROUND:Exosome, a kind of cystic vesicle with bilayer structure, is widely distributed in the body fluids. Exosomes are involved in various cel ular communications, and its contents including proteins, short chain peptides, DNA, RNA, phospholipids, and miRNA are resistant to degradation.
OBJECTIVE:To clarify the characters of exosomes, and to investigate the possibility of exosomal miRNAs as biomarkers for different diseases to provide a new strategy for clinical diagnosis.
METHODS:A computer-based search of CNKI and PubMed databases was performed by the first author for articles related to exosomal miRNAs. The keywords were“exosome, microvesicles, extracel ular vesicles, miRNA, biomarker, early diagnosis, progrosis”in Chinese and English, respectively. Total y 50 eligible articles were included in result analysis.
RESULTS AND CONCLUSION:After reviewing researches of exosomes in different diseases, we can confirm that exosomes broadly participant in physiological and pathological process of various system diseases. The abnormal expression of exosomal micro-RNAs has been identified in many studies, indicating the exosomal micro-RNAs have a great potential to be biomarkers for disease diagnosis. Further studies should focus on extracting the contents of exosomes, the pathogenesis of exosomes is involved in and screening the appropriate exosomal miRNAs for early diagnosis.

This paper presents the ultrastructrual changes of male rats gonadotrophs at 7, 15, 30, 50 days after cadmium chloride (Cd) injection (2mg/kg). The differences of morphometric parameters of gonadotrophs and plasma value of FSH were revealed by statistics.The results showed that no injured alterations were found in gonadotrophs but appeared castration like features. These changes feature were most prominent after 15 days and then recovered to normal gradually. The main alterations of gonadotrophs were dilatation, and proliferation and decrease in the specific surface of RER as well as there were low density materials in the dilated cisterna. The numerical and volume density of large and small secretion granules were decreased greatly in all of the treatment groups. The variance of diameter of the large and small secretion granules were not conspicuous and the differences of volume and numerical density of the mitochondria among the control and treatment groups were also no significance. The hypertrophy of Golgi complex of the gonadotrophs were very obvious and the number of the gonadotrophs were increased in the Cd treated rats. The plasma value of FSH measurement indicated that the FSH level increased after 7days and the highest value appeared after 15 days. However, it did not return to normal after 50 days. These results suggested that gonadotrophs were not susceptible to Cd. The hypertraphy, hyperplasia and increase in synthesis and secretion of the gonadotrophs resulted from feedback by the effect of Cd induced injury on testes.

Objective To improve the recognition of treatment of adult T lymphoblastic lymphoma (TLL) with Hyper-CVAD regime.Methods The turnovers of 7 cases treated with Hyper-CVAD regime were summarized.Results Among the 7 cases,1 case died after the first unfinished chemotherapy,1 case gained complete remission before autologous stem cell transplantation but relapsed after transplantation,3 cases gained complete remission until now,2 cases without transplantation relapsed and then gave up following treatments after treating with ICE regime or the virgin regime,but the therapeutic effects were poor.Conclusions Adult TLL should get early chemotherapy treatments,and some special characteristics should be noted,the treatment does not relate to the stage,the chemotherapy treatment should be carried out regularly and enough,radiation of mediastinum mass can be applied after 4 cycles of Hyper-CVAD regime,choose suitable transplantation method.

Carrying out the training of critical thinking in pathophysiology teaching is appropriate, and the medical students critical thinking ability can be achieved via construction of the awareness, and diverse teaching methods which include questioning, exploration and discussion.

Objective To review clinical characteristics and treatment of multiple endocrine neoplasia type 2A (MEN-2A).Methods The clinical data of 13 patients with MEN-2A admitted to our hospital between 1988 and 2011 were retrospectively reviewed.All 13 cases were diagnosed as pheochromocytoma with medullary thyroid carcinoma,presenting no hyperparathyroidism,including 8 cases who had medullary thyroid carcinoma before pheochromocytoma and 5 cases who had medullary thyroid carcinoma and pheochromocytoma simultaneously.All 13 cases underwent resection for pheochromocytoma; 9 cases had bilateral adrenal resection,including 4 cases undergoing laparoscopic resection for pheochromocytoma.Thyroidectomy with bilateral dissection of regional lymph nodes was performed in 10 patients,and nodule enucleation was performed in 3 remaining patients.Results Adrenal pathology reported pheochromocytoma in all cases,including 3 malignant cases.Thyroid pathology reported medullary thyroid carcinoma in all cases.All 13 patients were followed-up visit,10 cases survived and 3 died from distant metastasis of medullary thyroid carcinoma.Conclusions MEN-2A is a rare disease.Surgery is the only treatment for this disease ; when patients have both pheochromocytoma and medullary thyroid carcinoma,to first remove the pheochromocytoma is preferable.

Objective To discuss the relevance between the serum prostate specific antigen (PSA) level and the prostatic cancer biopsy detection rate after tamsulosin treatment for patients with lower urinary tract symptoms and elevated PSA level.Methods 168 patients with lower urinary tract symptoms and elevated PSA level were divided into two groups according to the serum PSA level change after tamsulosin treatment:in the first group,serum PSA level decreased slightly (PSA≥4.0 ng/ml and PSA decrease＜20％);in the second group,serum PSA level decreased obviously (PSA＜4.0 ng/ml or PSA decrease≥20％).Tamsulosin treatment was given in 0.2 mg/d for two months.Prostate gland aspiration biopsy was performed at the end of tamsulosin treatment.Result For the 68 patients of the first group,after tamsulosin treatment,the tPSA level increased from (8.11 ±2.09)ng/ml to (9.05±3.13)ng/ml,in which 38 patients (55.88％,38/68) were confirmed as the prostatic cancer by pathology.For the 100 patients of the second group,after tamsulosin treatment,the tPSA level decreased from(7.80±3.79)ng/ml to (5.19±2.32)ng/ml,in which 6 patients (6％,6/100) was confirmed as the prostatic cancer by pathology.There was significant statistical differences of prostate aspiration biopsy detection rate between the two groups(x2=23.53,P＜0.05).For patients with lower urinary tract symptoms who received tamsulosin treatment,the sensibility of PSA increased to 86.4％,specificity increased to 75.8％,the rate of avoiding aspiration was 55.9％,and the rate of correct diagnosis was 78.5％.Conclusion Tamsulosin treatment can increase the prostatic cancer diagnostic positive rate and decrease the aspiration rate in patients with lower urinary tract symptoms and elevated serum PSA level in a certain extent.

Objective To study the effect of esomeprazole,clarithromycin,metronidazole triple therapy for helicobactor pylori(Hp) infection in children.Methods Ninty-eight cases of children,identified by ~ 13 C-urea breath test(~ 13 C-UBT) Hp infection,deparded into therapy group(66 cases) and control group(32 cases).Therapy group were given Esomeprazole[0.8 mg/(kg?d),1 time/d],clarithromycin[15 mg/(kg?d),2 times/d],metronidazole[30 mg/(kg?d),3 times/d]triple therapy.Control group were given the same treatment except ameprazole.The course was 1 week.They were followed up 4 weeks later after the course and re-tested by ~ 13 C-UBT.Results The recurrent abdominal pain of the two groups recovered in different degrees,and the efficacy rate was 100%.The eradication rate of Hp in therapy group and control group were separately 90.9%(60/66) and 87.5%(28/32).There was no significance difference of the eradication of Hp.Conclusions The trearment of esomeprazole,clarithromycin,metronidazole triple therapy on Hp infection in children is quite effective and safe.The side effect is moderate.

Objective: To explore the impact of personality and locus of control on job burnout.Methods: Chinese Maslach burnout inventory,Eysenck personality questionnaire and internal-external locus of control scale were used to examine 247 judges.Results: Introversion-extroversion was a significant predictor of exhaustion(P

Objective To evaluate clinical significance of laparoscopic adrenalectomy for treatment of primary aldosteronism.Methods From Jan.1999 to Dec.2009,227 patients(92 males and 135 females)with a confirmed diagnosis of primary aldosteronism underwent laparoscopic adrenalectomy.The median age was 42years old,ranging from 22 to 69 years old.The median disease duration was 4.6 yeas,ranging from 2 months to 15 years.5 cases underwent peritoneal laparoscopic adrenalectomy and 222 cases underwent retropefitoneal laparoscopic adrenalectomy.All cases had hypokalemia,hpertension,high plasma aldosterone and low plasma rennin preoperatively.Of all the cases,there were 205 cases with aldosterone-producing adenomas among whom 80 cases underwent total adrenalectomy and 125 cases underwent partial adrenalectomy.There were 22 cases with unilateral adrenal hyperplasia and all of them underwent total unilateral adrenalectomy.Results Procedures were successfully performed in all the 227 cases.The operation duration ranged from 15 to 156 min(39 min as the median)and the blood loss ranged from 5 to 220 ml(20 ml as the median).The hospitalization time ranged from 5 to 9 days (6.9±1.2 days as the median).All the cases were followed up from 6 months to 2 years(1.2 years as the median).Postoperative potassium level resumed normal in all cases.Blood pressure resumed normal in 180 cases(80%).No adrenocortieal insufficiency and any other complication occurred.Conclusion Retropreitoneal laparoscopic partial or total adrenalectomy for treatment of primary aldosteronism is a safe and feasible procedure.

Objective To summarize clinical characteristics of ectopie pheochromocytoma in order to improve the diagnosis and treatment of this disease.Methods Clinical data of 36 cases of pathologically proved ectopic pheochromocytoma treated in Tianjin Medical University General Hospital from 1990 to 2010 were retrospectively analyzed.Hypertension was observed in 28 cases.5 cases had hypertension at the end of urination. 1 case was proved to have ectopic pheochromocytoma by physical examination.Abdominal pain occulted in 2 patients.Urinary VMA was measured in all the 36 cases,and 32 esges had an elevation of VMA(88.9%).The lesions were localized mainly by abdominal ultrosonggraphy,CT,MRI and 131 I-MIBG.All cages underwent operation,including 4 laparoscopic surgery.Results Of the 36 patients with ectopic pheochromocytoma,34 cases had sinsle tumor,and 2 cases had multiple tumors.The diameter of the lesions was from 3.4 cm to 18.2 cm in size.Postoperative pathological examination showed 27 cases of ectopic pheochromocytoma were benign and 9 cases were malignant.Conclusions VMA level is an important marker to detect ectopic pheochromocytoma.Tumor localization is difficult.131 I-MIBG is of great value for localization of the lesion.Meticulous preoperative preparation is extremely important.Surgical resection of the tumor is the best therapy.Laparoscopic surgery can be the new choice for treatment of ectopic pheochromocytoma.Patients with malignant ectopic pheochromocytoma may be treated with 131 I-MIBG after surgery.