BACKGROUND:Exosomes,as a type of extracellular vesicle,have become a key medium for cell-to-cell communication due to their nanoscale size and enrichment of various bioactive substances.The study of exosome secretion regulation not only has important scientific value,but also has broad application prospects in clinical practice,and is of great significance for promoting medical progress and improving human health.OBJECTIVE:To review the biological characteristics,biological functions,biogenesis process and biochemical regulation mechanism of exosomes,and to explore the application prospects of exosomes in disease diagnosis,treatment and vaccine development,so as to provide theoretical basis and reference for basic research and clinical transformation of exosomes.METHODS:The first author searched PubMed and CNKI databases in October 2024 for relevant literature published from January 2010 to October 2024.Key words were"exosomes,biological functions,biogenesis,secretion or release,regulatory mechanisms,application prospects"in Chinese and English.Finally,92 articles were included for analysis.RESULTS AND CONCLUSION:The secretion level of exosomes can be regulated through physical or biochemical means.Exosomes show broad application prospects in the fields of disease diagnosis,treatment,and vaccine development,and may play a key role in the treatment of cardiovascular and cerebrovascular diseases as well as cancer.This review provides valuable information for the clinical translation and application research of exosomes,helping to promote future progress in exosome research and application.

BACKGROUND:Exosomes,as a type of extracellular vesicle,have become a key medium for cell-to-cell communication due to their nanoscale size and enrichment of various bioactive substances.The study of exosome secretion regulation not only has important scientific value,but also has broad application prospects in clinical practice,and is of great significance for promoting medical progress and improving human health.OBJECTIVE:To review the biological characteristics,biological functions,biogenesis process and biochemical regulation mechanism of exosomes,and to explore the application prospects of exosomes in disease diagnosis,treatment and vaccine development,so as to provide theoretical basis and reference for basic research and clinical transformation of exosomes.METHODS:The first author searched PubMed and CNKI databases in October 2024 for relevant literature published from January 2010 to October 2024.Key words were"exosomes,biological functions,biogenesis,secretion or release,regulatory mechanisms,application prospects"in Chinese and English.Finally,92 articles were included for analysis.RESULTS AND CONCLUSION:The secretion level of exosomes can be regulated through physical or biochemical means.Exosomes show broad application prospects in the fields of disease diagnosis,treatment,and vaccine development,and may play a key role in the treatment of cardiovascular and cerebrovascular diseases as well as cancer.This review provides valuable information for the clinical translation and application research of exosomes,helping to promote future progress in exosome research and application.

OBJECTIVE To systematically evaluate the efficacy and safety of different chemotherapy combination regimens for first-line treatment of metastatic colorectal cancer （mCRC）. METHODS PubMed， Cochrane Library， Embase and Web of Science were electronically searched to collect randomized controlled clinical trial （RCT） on first-line treatment for mCRC from January 1， 2000 to February 16， 2025. Two reviewers independently screened literature， extracted data and assessed the risk of bias of the included studies. Network meta-analysis was performed by using R4.4.3 and Stata 17.0 software. RESULTS A total of 28 RCTs， involving 16 intervention measures， were included. In terms of prolonging progression-free survival （PFS） and overall survival （OS）， FOLFOX （5-fluorouracil+oxaliplatin+calcium folinate regimen）+cetuximab had the highest probability of ranking first. In terms of improving objective response rate （ORR）， FOLFOXIRI （5-fluorouracil+oxaliplatin+irinotecan+calcium folinate regimen）+ bevacizumab and FOLFOX+bevacizumab+nivolumab had the highest probability of ranking first； in terms of the incidence of grade 3 or higher adverse reactions， FOLFOXIRI+panitumumab had the highest probability of ranking first； in subgroup analysis of KRAS wild-type patients， FOLFIRI （5-fluorouracil+irinotecan+calcium folinate regimen）+panitumumab and FOLFIRI+bevacizumab had the highest probability of ranking first in terms of prolonging PFS and OS， respectively； in terms of ORR， FOLFOXIRI+ cetuximab had the highest probability of ranking first. CONCLUSIONS In first-line treatment for mCRC， FOLFOX combined with targeted therapy has advantages in terms of efficacy and safety. However， individualized treatment strategies should be formulated based on the KRAS gene status and tumor location of patients.

AIM: To investigate the effect of intravitreal injection of recombinant tissue plasminogen activator(r-TPA)before pars plana vitrectomy(PPV)on surgical outcomes in patients with rupture of the globe(RG).METHODS: A retrospective study was conducted on 37 patients(37 eyes)with RG who underwent PPV 7-10 d after Stage Ⅰ suturing and stabilization at our hospital between April 2020 and November 2023. Based on whether an intravitreal r-TPA injection was administered 1 d before PPV, patients were divided into two groups, with 14 cases(14 eyes)in pre-operative r-TPA injection group, and 23 cases(23 eyes)in control group without pre-operative r-TPA injection. The intraoperative retinal reattachment rate, intraoperative silicone oil application, postoperative intraocular rebleeding, postoperative hypotony, and best-corrected visual acuity(BCVA)were compared between the two groups.RESULTS: The baseline characteristics were comparable between the two groups(P>0.05). Significant differences were found between the two groups in the intraoperative retinal reattachment rate, the volume of silicone oil injected, and the proportion of BCVA(all P<0.05). No statistically significant differences were observed in the intraoperative silicone oil tamponade rate, postoperative intraocular rebleeding, or postoperative hypotony rates(all P>0.05).CONCLUSION: RG patients who received an intravitreal r-TPA injection 1 d before PPV demonstrated significantly higher intraoperative retinal reattachment rates and better postoperative visual acuity outcomes.

OBJECTIVE: To observe the clinical effect of needle cauterization on vitiligo with deficiency cold and blood stasis. METHODS: A total of 62 patients of vitiligo with deficiency cold and blood stasis were randomly divided into an observation group and a control group, 31 cases each group.On the basis of 308 nm excimer light irradiation combined with ironing with Chinese medicine, the control group was treated with tacrolimus ointment for external use, twice a day; the observation group was treated with needle cauterization at vitiligo spots, once a week.Both groups were treated for 10 weeks. Before and after treatment, the area of vitiligo spot, TCM syndrome score, serum levels of inflammatory indexes (interleukin[IL]-6 and IL-17) were observed in the two groups, and the clinical effect was evaluated. RESULTS: After treatment, the areas of vitiligo spot, TCM syndrome scores and serum levels of IL-6, IL-17 were decreased compared with those before treatment in both groups (P<0.05), and the above indexes in the observation group were lower than those in the control group (P<0.05). The total effective rate in the observation group was 93.5% (29/31), which was higher than 77.4% (24/31) in the control group (P<0.05). CONCLUSION Needle cauterization could reduce the areas of vitiligo spot in patients of vitiligo with deficiency cold and blood stasis, improve the clinical symptoms, its mechanism may be related to the reduction of serum levels of inflammatory indexes.
Humans ; Vitiligo/physiopathology* ; Male ; Female ; Adult ; Young Adult ; Middle Aged ; Adolescent ; Interleukin-6/blood* ; Interleukin-17/blood* ; Cautery ; Acupuncture Therapy/instrumentation* ; Needles ; Cold Temperature ; Treatment Outcome

Objective To understand the nursing practice of prone position ventilation for patients with moderate to severe acute respiratory distress syndrome(ARDS)in intensive care unit(ICU)in Shandong province,so as to provide basis for standardizing the nursing practice process of prone position ventilation and carrying out training for hospitals.Methods A self-made questionnaire was used,and convenience sampling was adopted.From September 15th to November 5th,2023,ICU nurses were selected from various hospital levels in Shandong province to investigate the obstructive factors of prone ventilation implementation,the weak links in nursing practice and status,and the occurrence of complications.Results A total of 1 188 questionnaires were collected,of which 991 were valid.92.8%(920/991)of nurses had performed prone position ventilation.The biggest obstacle to the implementation of prone position ventilation was the complexity of patient treatments and multiple devices involved[74.6%(686/920)].Regarding the status of training,90.5%(897/991)of nurses had received training on prone position ventilation and 77.0%(763/991)of nurses felt that training was needed.As for pre-operation assessment,more than 80.0%of nurses evaluated patients'vital signs,airway and secretions and so on,among which the evaluation awareness of analgesia was the worst[81.6%(751/920)].As for the main points of implementation,only 14.0%(129/920)of nurses chose the opposite side of the most important pipeline as the turning direction;48.6%(447/920)of nurses chose the anti-Trendelenburg position;36.3%(334/920)of nurses chose to ventilate≥12 hours.Facial edema[81.7%(752/920)],skin pressure injury[78.9%(726/920)]and eye complication[75.8%(697/920)]were the top 3 most frequent complications.Conclusions ICU nurses'prone position ventilation practices were generally line with the nursing team standard for prone position of adult mechanically ventilated patients and the best evidence recommendation,and needs to be further standardized in aspects of turning direction,position management,ventilation duration,and enteral nutrition management.It is recommended that nursing managers at all levels of hospitals further improve the quality of nursing practice of prone position ventilation according to relevant evidence-based evidence and the actual situation of hospitals.

Objective To determine the effects of dexmedetomidine(Dex)in anesthesia on brain function,cerebral oxygen uptake rate(CERO2),difference in glucose content between cerebral ar-terial and venous blood(A-VDG)and jugular bulb oxygen saturation(SjvO2)and stress response in elderly patients with hypertensive cerebral hemorrhage.Methods A total of 96 elderly patients with hypertensive cerebral hemorrhage admitted to our hospital from January 2021 to June 2024 were recruited,and according to different anesthesia schemes,they were divided into the group A(propofol,remifentanil,sevoflurane combined with rocuronium anesthesia,48 cases)and group B(same anesthesia regimen as group A plus Dex).Glasgow coma(GCS)score and restlessness-sedation score 48 h after operation,postoperative recovery,stress indexes and cerebral glucose and oxygen metabolism before(T1)and at the end of operation(T2),and adverse reactions during the study were compared between the two groups.Results When compared with the group A,the group B had significantly higher GCS score 48 after surgery(13.95±0.28 vs 12.89±0.41,P＜0.01),and shorter awakening time,time to regain spontaneous breathing,extubation time and response time(P＜0.01).At T2,the levels of CERO2,A-VDG and SjvO2 were notably higher,while levels of cortisol,norepinephrine and epinephrine,and activity of renin were remarkably lower in the group B than the group A(P＜0.01).At T2,the both groups obtained increased levels of cortisol,norepinephrine,epinephrine and renin activity and SjvO2,while decreased CERO2 and A-VDG levels than the corresponding levels at T1(P＜0.05).The incidences of nausea and vomiting,cough,chills,restlessness and delirium was obviously lower in the group B than the group A(P＜0.05,P＜0.01).Conclusion For elderly patients with hypertensive cerebral hemorrhage,application of Dex in anesthesia can improve cerebral glucose and oxygen metabo-lism,reduce stress response,maintain the stability of perioperative vital signs,decrease the severi-ty of coma and incidences of delirium,nausea and vomiting,cough,chills,restlessness and other adverse reactions,and thus promote postoperative recovery.

Objective The effect of intra-aortic balloon counterpulsation combined with recombinant human brain natriuretic peptide(rhBNP)treatment on ventricular remodeling after percutaneous coronary intervention(PCI)in elderly patients with acute anterior wall myocardial infarction.Methods A retrospective analysis was con-ducted on 66 elderly patients with acute anterior myocardial infarction who underwent emergency PCI in our hospital from January 2018 to June 2023.They were divided into a control group(n=32)who underwent PCI+rhBNP,and a study group(n=32)who underwent PCI+rhBNP+intra-aortic balloon counterpulsation.Blood pressure,lactic acid level,mechanical complications,ventricular remodeling,inflammatory factors,myocardial enzymology,ox-LDL level were detected and compared between the two groups.Results Before treatment,Lactic acid,diastolic blood pressure,systolic blood pressure,left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular posterior wall thickness(LVPWT),left ventricular remodeling index(LVRI),left ventricular ejection fraction(LVEF),homocysteine(Hcy),interleukin-6(IL-6)and myocardial troponin were compared between the two groups.Myocardial troponin T(cTnT),lactate dehydrogenase(LDH),creatine kinase isoenzyme(CK-MB),oxidized low density lipoprotein(ox-LDL)levels(P>0.05);At 3 months follow-up after discharge,the levels of lactic acid,LVESD,LVEDD,LVPWT,LVRI,Hcy,IL-6,cTnT,LDH,CK-MB and ox-LDL were decreased,and the levels were lower in the study group,and the levels of diastolic blood pressure,systolic blood pressure and LVEF were increased,and the levels were higher in the study group(P<0.05).The pro-portion of mechanical complications between the two groups before and after treatment were compared(P>0.05).Conclusion In elderly patients with acute anterior myocardial infarction after emergency PCI,intra-aortic balloon counterpulsation combined with rhBNP could alleviate ventricular remodeling,myocardial injury,reduce inflamma-tory injury,improve oxidative stress response,and regulate tissue perfusion.

Objective To explore the feasibility of spectral CT material decomposition technique Ca(Iodine)for opportunistic osteoporo-sis screening in enhanced scanning.Methods A total of 314 patients who underwent abdominal enhancement were selected.They were divided into group A and group B according to gender,and the groups were divided into three subgroups according to age(18-45 years,46-60 years,>60 years).The bone mineral density(BMD)values of L1-L3 vertebral were measured in the unenhanced images using quan-titative computed tomography(QCT)software,and Ca(Iodine)values were measured on three enhancement phases Ca(Iodine)based substance images.Pearson correlation analysis was performed between iodine intake and Ca(Iodine)values in three enhancement phases,Ca(Iodine)values and quantitative computed tomography bone mineral density(BMDQCT),and the diagnostic efficacy was analyzed.Results There was no significant difference in the Ca(Iodine)values of L1-L3 vertebral in three enhancement phases(F=0.001-0.018,P>0.05);there was no correlation between the Ca(Iodine)values of L1-L3 vertebral in three enhancement phases and iodine intake(r=0.073-0.105,P>0.05).Six groups of measured Ca(Iodine)values and BMDQCT both had a strong positive correlation(r=0.901-0.954,P<0.05).The Ca(Iodine)cutoff values for the diagnosis of osteoporosis and osteopenia were 830.41(2 mg/cm3)and 849.32(2 mg/cm3)respectively,with corresponding area under the curve(AUC)of 0.969[95%confidence interval(CI)0.943-0.985]and 0.973(95%CI 0.944-0.989),respectively.There were statistically significant differences in Ca(Iodine)values and BMDQCT in the>60 years age group between different genders(t=3.081-3.091,P<0.05).Conclusion Spectral CT material decomposition technique can be used for oppor-tunistic osteoporosis screening in enhanced scanning,with good diagnostic performance,which provides a new perspective for the clin-ical diagnosis of osteoporosis.

Purpose To explore the application value of auto-prescription technique in CT portal venography and liver volume measurement.Materials and Methods A total of 180 patients who underwent contrast-enhanced abdominal CT in the First Affiliated Hospital of Dalian Medical University from April to November 2022 were prospectively collected and randomly divided into two groups,with 90 cases in each group.Group A(experimental group)was scanned with auto-prescription technique.Group B(conventional group)was scanned with 120 kVp,and the other imaging parameters kept the same as group A.In group A,the correlation between body mass index and tube voltage(kVp)recommended by auto-prescription technique was analyzed.The following values were compared between group A and group B,including the volume CT dose index,dose length product,CT value of portal vein and liver,standard deviation,contrast-to-noise ratio(CNR),image quality and subjective score of automatic segmentation.The liver volumes of group A and B were measured by Liver Segmentation software.The volumes measured by automatic segmentation software(Vsoft)were recorded,and then were compared with those segmented manually(gold standard)(Vstnd).Results Compared with group B,the volume CT dose index and dose length product in group A decreased by 22%and 25%(t=-4.654,-5.403,both P<0.05),respectively.The CT value and CNR of portal vein and liver in group A were higher than those in group B(t=4.857-6.011,all P<0.05).There was no significant difference in standard deviation,Vstnd and Vsoft between group A and group B(P>0.05).The consistency of subjective scores between the two observers was good(ICC=0.773-0.856,all P<0.05).The subjective scores of two-dimensional and three-dimensional images,as well as the automatic software segmentation scores in group A were higher than those in group B(Z=897.500,1 287.500,912.721,all P<0.05).The recommended kVp value in group A was positively correlated with body mass index(r=0.674,P<0.001).Conclusion The application of auto-prescription technique in CT portal venography can ensure the image quality,measure the liver volume accurately,and reduce the patient's radiation dose individually.