Volume 96  ·  Issue 26  ·  2016

Atrial fibrillation (abbreviated as atrial fibrillation) is a risk factor for stroke, and patients can be found as stroke when they see the doctor because they have no obvious symptoms. Anticoagulation can reduce the incidence of stroke caused by atrial fibrillation, so early identification and management of patients with atrial fibrillation is very important for stroke prevention. Mobile medical care has the characteristics of convenient portability, anytime and anywhere operation, and a large amount of information storage. It can realize early identification and timely diagnosis and treatment of atrial fibrillation, thus achieving the purpose of preventing stroke.

To explore the clinical characteristics and impact of diabetes mellitus (DM) on prognosis in patients with nonvalvular atrial fibrillation (AF).

Data of nonvalvular AF patients in the Chinese Emergency Atrial Fibrillation Registry Study were retrospectively analyzed. The eligible patients were divided into the DM group and the non-DM group. Uni- and multi-variate Cox regression analysis were used to explore risk factors of 1-year outcomes.

A total of 1 644 patients were enrolled in the study with 227 patients combined with DM (16.8%). Compared with non-DM group, patients with DM were older and had higher body weight, had higher prevalence of myocardial infarction, coronary heart disease, hypertension and stroke, and were at higher risk of thromboembolism. The proportion of anticoagulant treatment was low in both groups (10.1% vs 7.4%, P=0.141). Compared with patients without DM, patients with DM had higher all-cause mortality (19.5% vs 12.7%, P=0.004), cardiovascular death (10.8% vs 7.02%, P=0.047) and combined end events (CEE, 26.4% vs 2.4%, P=0.023), while with comparable incidence of stroke (10.1% vs 7.4%, P=0.141). Multi-variate Cox regression analysis showed that DM was an independent risk factor for 1-year all-cause mortality (HR=1.558, 95% CI 1.126-2.156), cardiovascular death (HR=1.615, 95% CI 1.052-2.479) and CEE (HR=1.523, 95% CI 1.098-2.112), while not for stroke (HR=1.523, 95% CI 1.098-2.112).

DM is the independent risk factor for all-cause mortality, cardiovascular death and combined end events in patients with nonvalvular AF, while not a predictor for the occurrence of stroke.

To investigate the current situation, time trends and factors associated with long-term use of oral anticoagulation (OAC) among atrial fibrillation (AF) patients with ischemic stroke.

We used the dataset from the CAFR (Chinese Atrial Fibrillation Registry), a prospective, multicenter, hospital-based registry study involving 20 tertiary and 12 nontertiary hospitals in Beijing. In brief, 380 consecutive AF patients with following ischemic stroke were enrolled from 2003 to 2014.Patients with valvular AF, radiofrequency catheter ablation history or contraindications of OAC were excluded. We divided the patients into two groups according to hospital level, and investigated the rate of OAC use and its change over time in patients who had indication, the factors including patient characteristics and hospital level associated with OAC use were also analyzed.

Overall oral anticoagulation use rate was 27.71%, which dropped to 22.11% and 15.26% at 6 months and 12 months, respectively.A total of 298 participates were enrolled from tertiary hospitals (78.42%), and 82 were enrolled from nontertiary hospitals. The status of OAC use in tertiary hospitals was better than nontertiary hospitals (32.66% vs 7.32%, P<0.001). Multivariable analysis showed better oral anticoagulation use was independently associated with higher-level hospitals (odds ratio 1.785, 95% confidence interval 1.026-3.106,P=0.040), and history of heart failure (odds ratio 2.247, 95% confidence interval 1.235-4.090, P=0.008).

These data indicates oral anticoagulation use has improved in atrial fibrillation patients with stroke in Beijing. The use of anticoagulation among the patients from tertiary hospitals is significantly better than those from nontertiary hospitals, and the history of heart failure may have effect on the use of oral anticoagulation.

To observe the intravenous thrombolysis effect of rt-PA in different time windows of acute cerebral infarction with atrial fibrillation(AF).

Acute cerebral infarction patients who accepted the intravenous thrombolysis treatment with AF from January 2012 to December 2015 were included.According to the time from onset to intravenous thrombolysis, patients were divided into two groups: thrombolysis within 3 h and thrombolysis between 3-4.5 h. The Nation Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to evaluate early and long-time therapeutic effects. The incidence of hemorrhagic infarction(HI), parenchymal hemorrhage(PH) and symptomatic intracranial hemorrhage(sICH) after thrombolysis within 24 hours were observed in the two groups.

A total of 103 patients were included in the study, with 48 cases in thrombolysis within 3 h group and 55 cases in thrombolysis between 3-4.5 h group. After thrombolysis treatment, the 24-hour and 7-day NIHSS score of the two groups were significant lower than before treatment, and the difference was statistically significant(P<0.05). Compared between groups, 24-hour clinical efficacy of thrombolysis within 3 h group was better than that of thrombolysis between 3-4.5 h group, and the difference was statistically significant(P<0.05). There were no statistically significant differences between these two groups about 7-day and 90-day prognosis(P<0.05). The rate of PH in thrombolysis within 3 h group and thrombolysis between 3-4.5 h group is 6.3%(3/48) and 21.8%(12/55) individually, and the difference was statistically significant(P<0.05). While no statistically significant differences was found about the rate of HI(18.8% vs 32.7%,P>0.05) and sICH(8.3% vs 14.5%,P>0.05) between these two groups.

For patients of acute cerebral infarction with AF, intravenous thrombolytic therapy by rt-PA within 3 h may contribute to a greatly improvement in a short time. Thrombolysis between 3-4.5 h increase the incidence of PH, but do not increase the incidence of sICH. There are no statistically significant differences between these two groups about 90-day favorable prognosis, indicating that thrombolysis between 3-4.5 h is safe and effective for acute cerebral infarction patients with AF.

Atrial fibrillation (AF) is responsible for some thromboembolic events. Asymmetrical dimethylarginine(ADMA) increases in atrial fibrillation(AF) animals with dysfunction of endothelium, but its role in pro-thrombotic state of AF was unknown. The aim of our study was to explore the role of ADMA in predicting the pro-thrombotic state in AF and to reveal its mechanism.

One hundred and thirty-eight patients in the First Affiliated Hospital, Sun Yat-sen University, from 2010 to 2012, were enrolled (persistent atrial fibrillation group, PAF, n=80; paroxysmal atrial fibrillation group, Paf, n=30; sinus rhythm, SR, n=28). Plasma ADMA levels were detected by ELISA-kits. CHADS₂ and CHA₂DS₂-VASc scores were estimated for each patient.14 Beagles (pacing group, n=8; sham group, n=6) were subjected to rapid atrial pacing (RAP). ADMA level was detected after 4 weeks of RAP.

ADMA level was elevated significantly in patients with atrial fibrillation especially in patients with persistent atrial fibrillation, and showed a significant linear correlation to CHADS₂ and CHA₂DS₂-VASc score. With ADMA, ROC area under the curve was 0.865 in CHADS₂ score ≥2 and was 0.959 in CHA₂DS₂-VASc score ≥2 (P<0.001 respectively). After 4 weeks of RAP, ADMA level was elevated compared to sham group and before operation. ADMA showed a linear correlation with atrial fibrillation susceptibility(r=0.686, P=0.007).

ADMA levels are elevated both in AF patients and RAP beagles. ADMA correlates with stroke risk concerning with CHADS₂/CHA₂DS₂-VASc score. ADMA may become a new biomarker for predicting pro-thrombotic risk in AF.

To evaluate autophagy of melanocytes and its mechanism in patients with vitiligo and to analyze its correlation with clinical types of vitiligo.

Nine cases of segmental vitiligo (SV) and 11 cases of generalized vitiligo (GV) were recruited in Hangzhou Third Hospital between May 2014 and June 2015. Six people with healthy skin were recruited as controls. Epidermal melanocytes were obtained from the normal colour skin around the white spot area in SV and GV patients and from foreskin in controls for culture in vitro. Cultures for each group contained negative control and rapamycin (30 nmol/L) sub-groups. The autophagy was observed using transmission electron microscopy (TEM) and immunofluorescence laser scanning confocal microscope (LSCFM). Protein expressions of microtube-associated protein light chain 3 (LC3Ⅱ) and microphthalmia-associated transcription factor (MITF), tyrosinase (TYR), tyrosinase related protein (TYRP)1, and TYRP2 were detected by Western blot.

(1)Autophagy of melanocytes was observed under TEM and LSCFM in both SV and control groups before rapamycin treatment, but not in GV patients. The expressions of autophagosome and LC3Ⅱ protein were increased in melanocytes in SV, GV and control groups after autophagy induction(SV group 0.58±0.10 vs 0.37±0.06; GV group 0.57±0.16 vs 0.22±0.08; control group 0.67±0.09 vs 0.46±0.12), and the autophagy intensity was higher in the GV group compared to the SV group and the control group. (2)Before autophagy induction, the expressions of MITF, TYR, TYRP1, and TYRP2 protein were lower in the GV and SV patients compared with the control group; after autophagy induction, the expressions of MITF, TYR, and TYRP1 statistically significantly increased in melanocytes in all the three groups(all P<0.05), while TYRP2 protein expression was not significantly changed (allP>0.05).

Autophagy of melanocytes may be present in vitiligo and affect the expression of functional molecules, and is related with clinical type of vitiligo.

To identify basal-like breast carcinoma (BLBC)-specific microRNA (miRs) and its target gene and to investigate the distinct biological function.

Krüppel-like factor 12 (KLF12) 3'-UTR was constructed and luciferase reporter assay was performed for target gene. Expression levels of miR including its target genes were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR), Western blot and immunohistochemistry (IHC). Further functional analyses were conducted which included apoptosis.

Luciferase assay showed miR-205 directly targets KLF12 through binding its 3'-UTR (P=0.001 6). QRT-PCR revealed that miR-205 expression levels were exclusively lower in MDA-MB-468 cell lines (P=0.00 7) and BLBC tumor tissues (P=0.007 4; n=3), but KLF12 were highly expressed in MDA-MB-468 cell lines (P=0.003 9); knock-up of miR-205 expression by transfection with its mimics in MDA-MB-468 cells substantially increased miR-205 expression level (P=0.000) and reduced KLF12 expression level (P=0.038). Western blot displayed that KLF12 expression levels were higher in tumor tissues when compared with normal breast tissues (P=0.008 3; n=9). Knock-up of miR-205 expression by transfection with its mimics promoted MDA-MB-468 cells apoptosis (P=0.006 1).

Our results suggest that miR-205 is a miR specific for BLBC which exerts tumor suppression role through negative regulated proto-oncogene KLF12 and promote cell apoptosis. MiR-205 and KLF12 may provide potential diagnosis molecular biomarker and possible new approach for the treatment for BLBC.

To compare the clinical outcomes and costs associated with carbapenems and β-lactam/β-lactamase inhibitor combinations (BLBLIs) for the empirical treatment of patients with extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae bloodstream infections (BSIs).

The medical records of individuals diagnosed with ESBL-producing Escherichia coli and Klebsiella pneumoniae BSIs between January 2014 and June 2015 at Changhai Hospital were reviewed. Patients were divided into two groups based on the empirical therapy (carbapenems group and BLBLIs group). Propensity score matching in a 1∶1 ratio was used to match the patients from two groups. Clinical outcomes and costs were compared before and after matching.

One hundred and fifty-eight patients were analyzed, 93 in the carbapenems group and 65 in the BLBLIs group. Before matching, the two groups were significantly different in department distribution, tumor rate, deep vein catheter rate, urinary catheter rate, nasogastric tube rate, and mechanical ventilation rate (all P<0.05), and the carbapenems group had longer total length of stay (LOS) and post-BSI LOS (26.0 vs 18.0 d,P=0.029 and 12.0 vs 10.0 d, P=0.044) , higher hospital cost and daily hospital cost (84 120 vs 39 000 ￥, P<0.001 and 3 451 vs 2 574 ￥,P=0.002). After matching, the two groups had no significant differences in covariates such as sex, age, department distribution, pathogens, comorbidities, invasive interventions, LOS before BSI, multiple admissions, surgical rate during hospitalization and delayed antimicrobial therapy (all P>0.05). Finally, there were no differences between two groups in mortality, post-BSI LOS, total LOS, hospital cost and antimicrobial cost (allP>0.05).

BLBLIs may provide a reasonable carbapenem-sparing option for the empirical treatment of ESBL producers.

To explore the expression of major histocompatibility complex classⅠchain-related protein A and B (MICA/B) in operable lung adenocarcinoma and its clinical significance.

Between January 2002 and December 2003, 100 patients with operable lung adenocarcinoma in People's Hospital of Zhengzhou were collected. The expression of MICA/B was examined by immunohistochemistry staining.According to immunohistochemical staining, the cases with score ≥5 points were high expression of MICA/B while <5 points were low expression of MICA/B.Chi-square test was utilized to analyze the relationship between MICA/B expression and clinicopathologic features. The association between MICA/B protein and overall survival in the patients with operable lung adenocarcinoma was analyzed by Kaplan-Meier survival curve, together with Log-Rank test. The COX regression model was established to analyze the single and combined effects of these covariants.

The percentage with high expression of MICA/B protein in operable lung adenocarcinoma tissue was 38% (38/100). The over-expression rate of MICA/B protein in the group with mutant epidermal growth factor receptor (EGFR) gene was significantly higher than that in the group with wild EGFR gene (93.8% vs 11.8%, P<0.001). No statistical significance was observed between the expression of MICA/B protein and other clinicopathologic parameters, including age, sex, TNM stage, T- staging, histological grade and lymph node metastasis. Kaplan-Meier analysis showed that overexpression of MICA/B protein was closely associated with shorter survival time (10.4 vs 28.9 months,P=0.005).

Overexpression of MICA/B in operable lung adenocarcinoma tissue is closely related to the mutations of EGFR and overall survival, which may be a poor prognosis indicator in patients with operable lung adenocarcinoma.

To observe the interleukin-17 (IL-17) expression in lung tussiue of patients with stable chronic obstructive pulmonary disease (COPD) and investigate the clinical significance.

A total of 50 patients receiving lung resections in General Hospital, Tianjin Medical University for lung cancer from October 2010 to October 2011 were included and divided into non-smoking COPD group (NS group), smoking non-COPD group (S group), smoking COPD group (COPD group) according to smoking status and 2013 COPD diagnosis standard. The expression of IL-17 was detected by immumohistochemical staining. The volume of IL-17 in the airway and lung parenchyma was calculated by immumohistochemical staining scores which was product of dyeing cells positive rate and intensity. Pearson correlation analysis was used to analyze the relationships between expression of IL-17 in the airway and lung parenchyma and forced expiratory volume in 1 second/predicted value (FEV₁%pred), carbon monoxide diffusion amount accounting for the percentage of the expected value (DLCO%pred), COPD assessment test (CAT) score, body mass index (BMI).

The expressions of IL-17 in airway and lung parenchyma in S group (5.6±3.1, 6.4±2.5) were higher than those in NS group (1.6±1.4, 1.4±1.2) (both P<0.05), while expressions in COPD group (7.3±2.5, 7.8±2.1) were further higher than S group (bothP<0.05). In the S group and COPD group, the expressions of IL-17 in the airway and lung parenchyma were positively correlated with smoking (r=0.453, P=0.007 and r=0.573, P<0.001); In the COPD group, the expressions of IL-17 in the airway and lung parenchyma were negatively correlated with FEV₁%pred (r=-0.729, P=0.001 and r=-0.489, P=0.039), negatively related with DLCO%pred (r=-0.493, P=0.038 and r=-0.520, P=0.027), positively correlated with COPD CAT score (r=0.730, P=0.001 and r=0.644, P=0.004) and negatively related with BMI (r=-0.653, P=0.003 and r=-0.485, P=0.041).

Smoking increases inflammation of lung tissue, increases IL-17 expression in airway and lung parenchyma; the expression of IL-17 is closely related to the severity of disease, the quality of life and prognosis in COPD patients.

To analyse and explore the indications and efficacy of liver transplantation for benign liver tumor.

From Jan.2001 to Dec.2014, 6 patients, incluing 3 males and 3 females, with benign liver tumor underwent liver transplantation in our department.There were 2 cases of hepatic epithelioid hemangioendothelioma, 1 case of hepatic cavernous hemangioma, 1 case of liver mesenchymal hamartoma, 1 case of hilar bile duct mucinous cystadenoma, and 1 case of hepatic adenoma. The data of surgical procedure, perioperative complications, postoperative management, and the outcome of follow-up were analyzed.

Six orthotopic liver transplantation from one living donor and five cadaveric donors were performed. One patient died in the perioperative period, and other patients were discharged with normal liver and kidney function. Within the follow-up time of 22 to 88 months, these patients could live the normal lives with stable graft function and nutritional status.

Liver transplantation is the most efficient treatment for unresectable and symptomatic benign lesions, with the favourable outcome.

To investigate the expression of RhoA/Rho-kinase (ROCK) in penile corpus cavernosum smooth muscles in rats of hyperlipidemia-induced erectile dysfunction and its molecular mechanism.

Forty male Sprague-Dawley rats were randomly divided into control and experimental groups using a random number table. Rats in the control group (n=20) were fed with regular diet for 24 weeks and those in the experimental group (n=20) with high-fat diet for the same period of time. The serum lipids profile was detected before and after the diet treatment. The ratio of intracavernosal pressure (ΔICP)/mean arterial pressure (MAP) was measured, and Western blot was used to detect the expression of total RhoA, ROCK1, and ROCK2 in penile corpus cavernosum smooth muscles, and RhoA protein in cell membrane and cytoplasm of smooth muscles after 24 weeks.

After 24 weeks, the levels of cholesterol, triglyceride, and low-density lipoprotein were significantly higher in the experimental group compared with those before diet treatment and the control group (all P<0.01). ΔICP/MAP in the experimental group was greatly lower than in the control group (P<0.01). The protein expression of ROCK2 in penile corpus cavernosum smooth muscles was higher in the experimental group than in the control group (0.77±0.10 vs 0.27±0.08,P<0.01) after 24 weeks, while no statistically significant differences were observed in total RhoA and ROCK 1 protein expression between the two groups (bothP>0.05). RhoA expression in cytoplasm was lower in the experimental than in the control group (1.66±0.09 vs 1.79±0.15,P<0.05). The ratio of RhoA expression in menmbrane/cytoplasm was higher in the experimental than in the control group (0.33±0.09 vs 0.26±0.07,P<0.05).

Up-regulation of RhoA/ROCK may be involved in hyperlipidemia-induced erectile dysfunction in rats.

In recent years, with the emergence of oral technology and new materials, patients with denture defects have more choices in restoration methods. However, due to the limitation of bone mass, general condition and economic conditions, removable partial dentures are still widely used in clinical practice. Most patients with dentition defects are accompanied by periodontal disease of varying degrees at the same time. Not only the tooth loss and extraction due to periodontal disease, but even the health of abutment after wearing removable partial dentures is still affected and threatened by periodontal disease. Whether denture itself promotes the progression and deterioration of periodontal disease is an urgent problem to be studied. In this study, the effects of removable partial dentures on the periodontal abutment were investigated by observing the periodontal changes of abutment after the restoration of removable partial dentures with Kennedy class I denture defects.

A 25-year-old male was admitted to the hospital on July 6, 2014 due to "repeated cough, hemoptysis for more than 1 month, chest pain and shortness of breath for 8 days". In early June 2014, the patient developed paroxysmal cough with blood in sputum without obvious trigger. CT pulmonary angiography (CTPA) in the local hospital showed pulmonary artery embolism in the left lower lobe of the lung, inflammation in the lower lobes of both lungs, and bilateral pleurisy. The international standardized ratio (INR) of monitoring was 2.00~4.88 after low molecular weight heparin, warfarin anticoagulant therapy and anti-infection therapy. On June 28th, chest pain, shortness of breath and low fever began to appear. Re-examination of CTPA showed that the filling defect in the pulmonary artery in the lower lobe of the left lung was still visible. He came to our hospital for further diagnosis and treatment.

The patient was a 52-year-old Han female with no smoking history. On August 17, 2015, he went to the Department of Respiratory Medicine, Affiliated Hospital of Putian University for "cough and expectoration for more than 1 month". Bronchoscopy after admission showed: nodular protrusion in the anterior wall of the upper main bronchus; The bronchial mucosa of the right upper lobe and middle lobe of the right lung was rough and hypertrophic. Chest CT showed high-density foci, metastasis or inflammation in the lingual segment of the left lung; Inflammation of the middle lobe of the right lung. Immunohistochemical biopsy specimens from right lung puncture biopsy (Fuzhou General Hospital, Nanjing Military Region) showed solid adenocarcinoma, partially micropapillary carcinoma (Figure 1)。 Twenty-nine gene mutation sites in exons 18, 19, 20 and 21 of epidermal growth factor receptor (EGFR) gene of chromosome 7 were detected by real-time quantitative fluorescence PCR. The results showed that the L858R gene mutation site in exon 21 of EGFR gene was detected (Figure 2)。

Patient, male, 68 years old. He was admitted to the Seventh People's Hospital affiliated to Shanghai University of Traditional Chinese Medicine on November 8, 2015 with "progressive enlargement of right scrotal mass for 1 month with pain and discomfort". Physical examination: The general condition is good, there are no abnormalities in the heart and lungs, the abdomen is soft, and the mass is not reached. The right scrotum is obviously enlarged, and a substantial mass about 9 cm ×8 cm in size can be palpable. It is hard in texture, and the surface is not smooth. It is fixed with the right testis and spermatic cord, with unclear boundary and slight tenderness. The mass cannot be returned to the abdominal cavity after lying down, and the light transmission test is negative. Serum tumor markers β-chorionic gonadotropin (β-hCG) 0.1 U/L and alpha-fetoprotein (AFP) 1.39 μ g/L were normal. B-ultrasound examination showed 8.2 cm ×7.8 cm ×7.1 cm heterogeneous mass echo in the right scrotum. CT showed a solid tumor of 7.0 cm ×7.5 cm ×7.0 cm in the right scrotum, and no obvious enlarged lymph nodes were found (Figure 1)。

The patient was a 60-year-old male. In January 2015, the patient developed yellowing of the skin sclera without obvious trigger, the color of the stool became lighter and white clay-like, and the color of the urine deepened. No abdominal pain, abdominal distension, skin itching, etc. Admission physical examination: moderate yellow staining of skin and mucosa throughout the body, and negative physical examination by oncology specialist. Liver and kidney function test on 21 January 2015: alanine aminotransferase 253 U/L, aspartate aminotransferase 172 U/L, total bilirubin 503.6 μ mol/L, direct bilirubin 380 μ mol/L, indirect bilirubin 23.60 μ mol/L, normal renal function. CT plain scan showed that there was a nodule with a size of 2.4 cm ×2.1 cm in the lumen of the common bile duct, which showed mild to moderate enhancement, and an irregular cystic-solid mass with a size of about 5.1 cm ×3.9 cm was visible at the lower pole of the left kidney, protruding from the contour of the kidney, and the solid components and partitions showed progressive enhancement. Due to the severe jaundice of the patient, percutaneous transhepatic biliary drainage was performed to reduce jaundice on January 27 of the same year. Liver function returned to normal after more than 1 month. Abdominal MR enhanced scan: An irregular mass of 5.1 cm ×5.1 cm in size was seen at the lower pole of the left kidney, with clear boundaries, T1WI/DUAL low signal and T2WI/FS mixed high signal. The enhanced scan showed obvious enhancement in the arterial phase, gradual clearance in the portal vein phase, and the mass convexed outside the renal contour. The inferior renal calyx was involved, which was considered kidney cancer. CT and magnetic resonance imaging (MRI) findings revealed ampullary tumor and left kidney tumor. Admission diagnosis: ampullary carcinoma, obstructive jaundice, left kidney cancer.

Stress ulcer (SU) refers to acute gastrointestinal mucosal erosion, ulcer and other lesions that occur under various stress states such as severe trauma, critical illness or severe mental illness, which can invade the submucosa, muscle layer and blood vessels, cause hemodynamic changes, thus leading to gastrointestinal bleeding and even perforation, which can aggravate and worsen the original disease and increase the mortality rate. Therefore, prevention of SU is a link that cannot be ignored in the treatment of critically ill patients. However, in recent years, there are some controversies about the necessity of prevention of SU and the choice of drugs. In this paper, the pathogenesis, epidemiological characteristics, prevention status of SU and the role of proton pump inhibitors in the prevention of SU are described.

Autoimmune hemolytic anemia (AIHA) is an anemia caused by the body producing antibodies against its own red blood cells and dissolving broken red blood cells. The incidence rate is 0.8% ~3.0%, and the mortality rate is about 11%. In recent years, some progress has been made in the treatment of AIHA, which is reviewed in this article.

Most patients with myelodysplastic syndrome (MDS) have anemia at the time of diagnosis and progressively exacerbate, eventually developing into transfusion dependence. The main causes of iron overload in MDS patients are transfusion dependence and ineffective hematopoiesis. Iron overload can significantly reduce the life expectancy of patients with MDS and increase their risk of conversion to acute myeloid leukemia (AML). Deferrotherapy significantly improves the prognosis of patients with MDS, prolongs their survival and reduces their risk of conversion to leukemia. This article expounds the causes of iron overload in MDS patients and the influence of iron overload on the prognosis of MDS.

Extracellular vesicles (EVs) are part of source cells and carry substances such as source cell-specific proteins and nucleic acids. Prostate-derived EVs are produced by prostatic epithelial cells through budding or secretion by storage granules, among other forms. If such a collective carrier carrying a part of the biologically active substance of the source cell can be separated from a body fluid such as blood, urine, prostatic fluid, or semen, the biological characteristics of the source cell can be detected non-invasively. Similarly, prostate cancer (Pca) cells can also produce specific EVs, which may provide direct evidence for the diagnosis, treatment selection, efficacy evaluation, prognosis evaluation and recurrence monitoring of prostate cancer after isolation and detection. The research progress of EVs liquid biopsy in the diagnosis and treatment of Pca is reviewed as follows.