[The development and innovation of clinical nutrition].

The strategy of nutrition therapy in the treatment of diseases is constantly optimized with the development and innovation of the concept and technology in the field of clinical nutrition, especially the rise of multi-disciplines such as imaging omics and artificial intelligence and the latest discoveries of clinical trials. Precise nutrition assessment, diversified products, multimodal nutrition therapy throughout the process and intelligent compliance management have efficiently improved the effect of nutrition therapy. The implementation of personalized and precise nutrition therapy still needs further investigation.

[Malnutrition in advanced gastrointestinal cancer patients and nutritional support therapy].

The advancement of comprehensive treatment has allowed an increasing number of patients with gastrointestinal tumor to achieve long-term survival. In current clinical practice, there is a growing population of patients with advanced gastrointestinal tumor. Due to various factors, such as tumor burden, treatments including chemotherapy and radiation therapy, as well as underlying diseases, patients with advanced gastrointestinal tumor often experience malnutrition, which negatively impacts their clinical outcomes. The mechanism of malnutrition in patients with advanced gastrointestinal tumor is complex, and conventional nutritional support therapy has shown limited effectiveness. With the continuous progress in the concept and technique of nutritional support therapy, the diversification of treatment strategies, and the strengthening of multidisciplinary collaboration, the nutritional management for patients with advanced gastrointestinal tumor tends to be standardized and rational, leading to effective improvement in patients' nutritional status and clinical outcomes. Based on the latest evidence-based medicine, combined with the author's practical experience and insights, this article aims to explore nutritional support therapy for patients with advanced gastrointestinal tumor.

[Association between CD4+T lymphocyte and body composition with physical frailty among elderly HIV-infected patients in Chongqing City].

Objective: To identify the association between CD4+T lymphocyte (CD4) counts and physical frailty among HIV-infected people aged 65 years and older, and evaluate whether this association will be modified by the indicators of body composition. Methods: From May to October 2022, 485 elderly HIV-infected patients receiving antiretroviral therapy (ART) were recruited from 7 antiviral treatment sites in Jiangjin District Center for Disease Control and Prevention, Chongqing. The data of basic characteristics (age and gender), living habits (smoking and drinking) and disease history (metabolic diseases, cardiovascular and cerebrovascular diseases, respiratory disease and malignant tumors) were collected through the face-to-face investigation with self-made questionnaires. Fried Frailty Scale was used to evaluate the status of physical frailty. Physical fitness (walking speed, grip strength, height, and weight) and body composition (skeletal muscle mass, body fat mass, and basal metabolic rate) were measured. The antiretroviral treatment data were obtained from the China AIDS Integrated Prevention and Treatment Data information management system. The prevalence of physical frailty was calculated among the HIV-infected patients. The potential effects of CD4 counts on physical frailty were explored by using multivariate logistic regression. Subgroup analyses were repeated in the logistic regression with muscle mass, body fat mass, and other indicators of body composition as subgroup variables to determine whether the association might be modified by body composition. Results: The age of 485 patients were (72±5) years old, of which 48.2% (234 cases) were>70 years old and 70.9% (344 cases) were male, and all of whom had initiated the ART treatment. The prevalence of physical frailty among these patients was 7.4% (36/485). Multivariate logistic regression showed that after adjusting for age, sex, smoking, drinking, body composition index, ART duration, viral load and the number of comorbidities, increased CD4 cell level was associated with decreased prevalent risk of physical frailty among elderly HIV-infected patients. For every increase of 5.0×107 CD4 cells/L, the prevalent risk of physical frailty decreased by 12% [OR (95%CI): 0.88 (0.76-1.01)]. Compared with the low CD4 cell level group, the risk of physical frailty in those with normal CD4 cell level decreased by 69% [OR (95%CI): 0.31 (0.10-0.92)]. Subgroup analysis of body composition indicators showed that the protective effect of normal CD4 cell level on physical frailty was more pronounced in the high skeletal muscle mass and high basal metabolic rate group (Pinteraction<0.05). Conclusion: The prevalence of physical frailty among elderly HIV-infected patients is relatively lower in Chongqing, and the CD4 cell level, skeletal muscle mass and basal metabolic rate are related to physical frailty.

[Risk factors for pulmonary atelectasis in adults with tracheobronchial tuberculosis].

Objective: To investigate the risk factors for pulmonary atelectasis in adults with tracheobronchial tuberculosis(TBTB). Methods: Clinical data of adult patients (≥18 years old) with TBTB from February 2018 to December 2021 in Public Health Clinical Center of Chengdu were retrospectively analyzed. A total of 258 patients were included, with a male to female ratio of 1∶1.43. The median age was 31(24, 48) years. Clinical data including clinical characteristics, previous misdiagnoses/missed diagnoses before admission, pulmonary atelectasis, the time from symptom onset to atelectasis and bronchoscopy, bronchoscopy and interventional treatment were collected according to the inclusion and exclusion criteria. Patients were divided into two groups according to whether they had pulmonary atelectasis. Differences between the two groups were compared. Binary logistic regression was used to analyze the risk factors for pulmonary atelectasis. Results: The prevalence of pulmonary atelectasis was 14.7%, which was most common in the left upper lobe (26.3%). The median time from symptom onset to atelectasis was 130.50(29.75,358.50)d, and the median time from atelectasis to bronchoscopy was 5(3,7)d. The median age, the proportion of misdiagnosis of TBTB before admission, and the time from symptom onset to bronchoscopy in the atelectasis group were higher than those without atelectasis, and the proportion of receiving bronchoscopy examination and interventional therapy previously, and the proportion of pulmonary cavities were lower than those without atelectasis (all P<0.05). The proportions of cicatrices stricture type and lumen occlusion type in the atelectasis group were higher than those without atelectasis, while the proportions of inflammatory infiltration type and ulceration necrosis type were lower than those without atelectasis (all P<0.05). Older age (OR=1.036, 95%CI: 1.012-1.061), previous misdiagnosis(OR=2.759, 95%CI: 1.100-6.922), longer time from symptom onset to bronchoscopy examination (OR=1.002, 95%CI: 1.000-1.005) and cicatrices stricture type (OR=2.989, 95%CI: 1.279-6.985) were independent risk factors for pulmonary atelectasis in adults with TBTB (all P<0.05). Of the patients with atelectasis who underwent bronchoscopy interventional therapy, 86.7% had lung reexpansion or partial reexpansion. Conclusions: The prevalence of pulmonary atelectasis is 14.7% in adult patients with TBTB. The most common site of atelectasis is left upper lobe. The TBTB type of lumen occlusion is complicated by pulmonary atelectasis in 100% of cases. Being older, misdiagnosed as other diseases, longer time from onset of symptoms to bronchoscopy examination, and being the cicatrices stricture type are factors for developing pulmonary atelectasis. Early diagnosis and treatment are needed to reduce the incidence of pulmonary atelectasis and increase the rate of pulmonary reexpansion.

[Post-tuberculosis lung disease: a neglected disease].

Globally, the number of patients with post-tuberculosis lung disease (PTLD) is huge, with high morbidity and mortality. PTLD is defined as chronic respiratory abnormality that affects large and small airways (bronchiectasis and obstructive lung disease), lung parenchyma, pulmonary vasculature, and pleura and may be complicated, with or without symptoms, attributable at least in part to previous pulmonary tuberculosis. The aforementioned chronic respiratory abnormality may be complicated due to coinfection such as fungi and nontuberculosis mycobacteria. Risk factors for PTLD include multiple episodes of tuberculosis, drug-resistant tuberculosis, delays in diagnosis, smoking, and possible diabetes. Empirical expert opinion advocates preventive anti-tuberculosis treatment for high-risk groups of tuberculosis, early diagnosis and treatment of tuberculosis, surgical treatment for specific groups, pulmonary rehabilitation for patients after tuberculosis treatment, early identification and treatment of co-infection. It is effective to prevent the occurrence of PTLD, improve the treatment effect, and prevent the deterioration of the disease. As a high TB burden country, PTLD has been seriously neglected in China. Internationally, there is currently a lack of epidemiological survey data on post-TB pulmonary disease, and there are few studies on its clinical characteristics, risk factors, prevention, and treatment. With an emerging literature on PTLD, collaborative research is urgently needed to inform our understanding of the natural history, prevention, and treatment of PTLD, and to allow for the development of much needed evidence-based guidelines.

[Effect of CD4-positive T lymphocyte expression rate on pain control and prognosis in stage â £ non-small cell lung cancer patients with cancerous pain].

Objective: To investigate the effect of CD4-positive T lymphocyte expression rate on the pain control and prognosis of stage Ⅳ non-small cell lung cancer (NSCLC) patients with cancerous pain. Methods: The clinical data of 128 stage Ⅳ NSCLC patients with cancerous pain who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from January to December 2020 were retrospectively analyzed, including 92 males and 36 females, with a male-to-female ratio of 23∶9 and an average age of (56±21) years old. The expression rate of CD4-positive T lymphocytes in peripheral blood was routinely detected on admission, and the expression rate of CD4-positive T lymphocytes ≥45% was defined as the CD4 high expression group, and<45% was defined as the low expression group. The differences in the time required for pain control, the dosage of opioids and the incidence of adverse reactions between the two groups were compared and analyzed. Survival analysis was performed by Kaplan-Meier method, and the overall survival (OS) time and progression-free survival (PFS) time of the two groups were calculated. Cox regression model was used to analyze the influencing factors of patients' OS time and PFS time. Results: The median time required for pain control in the high CD4 expression group [M (Q1, Q3)] was 18.6 (4.6, 21.5) h, which was lower than that in the low CD4 expression group [28.2 (7.1, 38.9) h] (P=0.012). The dosage of morphine in the CD4 high expression group [M (Q1, Q3)] was 88.6 (42.5, 295.0) mg, which was lower than that in the low expression group [145.8 (82.5, 442.5) mg] (P=0.010). There was no significant difference in the incidence of adverse reactions such as nausea and vomiting, constipation, urinary retention, intestinal obstruction, and respiratory depression between the two groups (all P>0.05). The OS time and PFS time in the CD4 high expression group [M (Q1, Q3)] were 12.5 (8.1, 13.8) months and 8.5(3.1, 9.4) months, respectively, which were higher than those in the CD4 low expression group [8.6 (4.1, 12.9) months and 6.5 (2.1, 7.9) months, respectively] (all P<0.01). Cox multivariate analysis showed that high expression of CD4 was a protective factor affecting OS (HR=0.876, 95%CI: 1.224-6.641, P=0.004) and PFS (HR=0.675, 95%CI: 1.742-5.930, P=0.031) Conclusion: The stage Ⅳ NSCLC patients with cancerous pain and high expression of CD4-positive T lymphocytes have shorter pain control time, less morphine dosage, and longer OS and PFS time.

A study on the mechanism of PP2A in the recovery of SCI in rats through downregulation of MMP-9 via MAPK signaling pathway.

OBJECTIVE: The aim of this study was to investigate the mechanism of action of protein phosphatase 2A (PP2A) in the recovery of spinal cord injury (SCI) in rats by downregulating matrix metalloproteinase 9 (MMP-9) via the mitogen-activated protein kinase (MAPK) signaling pathway. MATERIALS AND METHODS: A model of SCI was first successfully established in rats. A total of three groups were set, including: sham operation group (A group), SCI group (B group) and PP2A group (C group). The Basso, Beattie and Bresnahan (BBB) motor function score and inclined plane test were adopted to evaluate the motor ability and limb muscle strength of rats in each group. The water content in spinal cord tissues was detected as well. Quantitative Polymerase Chain Reaction (qPCR) assay was performed to analyze the messenger ribonucleic acid (mRNA) expression levels of MAPK, MMP-2, and MMP-9 in spinal cord tissues. The expressions of inflammatory factors tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß) and IL-6 in each group of rats were determined via enzyme-linked immunosorbent assay (ELISA). Western blotting (WB) was employed to measure the protein expression levels of MAPK, MMP-2 and MMP-9 in each group of rats. Additionally, the apoptosis of nerve cells in spinal cord tissues was analyzed through terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. RESULTS: The BBB score was 8.8 points in C group at 5 d after operation, which was significantly different from that in B group (p<0.05). The slope in B and C groups was clearly lower than that in A group at each time point (p<0.001). Meanwhile, it was significantly higher in C group than that in B group at 5, 7 and 9 d (p<0.05). The edema rate rose notably in B group compared with A group (p<0.001). However, spinal cord edema was remarkably relieved after treatment with FRY720 (p<0.01), suggesting that PP2A agonist could treat SCI in rats. The levels of cytokines TNF-α, IL-1ß and IL-6 were markedly higher in B group than those in A group (p<0.01). However, they were significantly reduced after treatment with PP2A agonist (p<0.01). In comparison with A group, B group exhibited remarkably decreased mRNA expression of MAPK and elevated mRNA expressions of MMP-2 and MMP-9 (p<0.01). However, C group exhibited an upregulated mRNA expression of MAPK (p<0.05), a downregulated mRNA expression of MMP-9 (p<0.01), and an undifferentiated mRNA expression of MMP-2 (p>0.05). Compared with B group, the protein expression level of MAPK significantly increased (p<0.05), while that of MMP-9 evidently decreased in C group (p<0.05). Besides, no statistically significant difference was observed in the protein expression level of MMP-2 between C group and B group (p>0.05). Compared with that in A group, the apoptosis rate significantly increased in B group (p<0.001). In addition, the apoptosis rate was significantly lower in C group than that in B group, showing a statistically significant difference (p<0.01). CONCLUSIONS: PP2A downregulates MMP-9 through the MAPK signaling pathway, thereby conducing to the recovery of SCI in rats.

[Advances in the prevention and treatment of postoperative ileus].

With the development and progress in the concepts and techniques of perioperative management, especially the latest reports of clinical trials, the prospect of prevention and treatment of postoperative ileus (POI) is promising. Proper nutritional support therapy, optimized surgical and anesthetic treatment, individualized fluid management, timely psychosocial intervention, and active anti-inflammation and traditional Chinese medicine treatment can effectively reduce occurrence of POI. Nevertheless, how to optimize and combine perioperative treatments to comprehensively prevent and treat POI still needs further study.

[Meta-analysis of laparoscopic versus open surgery for palliative resection of the primary tumor in stage IV colorectal cancer].

Objective: To systematically evaluate the safety and efficacy of laparoscopic versus open surgery for palliative resection of the primary tumor in stage IV colorectal cancer. Methods: The databases of CNKI, Wanfang, VIP, PubMed, EMBASE and Cochrane Library were searched to retrieve randomized controlled trials (RCT) or clinical controlled trials (CCT) comparing laparoscopic surgery with open surgery for palliative resection of the primary tumor in stage IV colorectal cancer published from January 1991 to May 2019. Chinese search terms included "colorectum/colon/rectum" , "cancer/malignant tumor" , "laparoscopy" , "metastasis" , " IV" ; English search terms included "laparoscop*" , "colo*" , "rect*" , "cancer/tumor/carcinoma/neoplasm" , " IV" , "metasta*" . Inclusion criteria: (1) RCT or CCT, with or without allocation concealment or blinding; (2) patients with stage IV colorectal cancer that was diagnosed preoperatively and would receive resection of the primary tumor; (3) the primary tumor that was palliatively resected by laparoscopic or open procedure. Exclusion criteria: (1) no valid data available in the literature; (2) single study sample size ≤20; (3) subjects with colorectal benign disease; (4) metastatic resection or lymph node dissection was performed intraoperatively in an attempt to perform radical surgery; (5) duplicate publication of the literature. Two researchers independently evaluated the quality of the included studies. In case of disagreement, the evaluation was performed by discussion or a third researcher was invited to participate. The data were extracted from the included studies, and the Cochrane Collaboration RevMan 5.1.0 version software was used for this meta-analysis. Results: Four CCTs with a total of 864 patients were included in this study, including 216 patients in the laparoscopic group and 648 patients in the open group. Compared with the open group, except for longer operation time (WMD=37.60, 95% CI: 26.11 to 49.08, P<0.05), laparoscopic group had less intraoperative blood loss (WMD=-74.89, 95% CI: -144.78 to -5.00, P<0.05), earlier first flatus and food intake after surgery (WMD=-1.00, 95% CI: -1.12 to -0.87, P<0.05; WMD=-1.61, 95%CI: -2.16 to -1.06, P<0.05), shorter hospital stay (WMD=-2.01, 95% CI: -2.21 to -1.80, P<0.05) and lower morbidity of postoperative complication (OR=0.52, 95% CI: 0.35 to 0.77, P<0.05). However, no significant differences were found in time to start postoperative chemotherapy, postoperative chemotherapy rate, and mortality (P > all 0.05). Conclusion: Laparoscopic surgery for palliative resection of the primary tumor is safe and feasible to enhance recovery after surgery by promoting postoperative bowel function recovery, shortening hospital stay and reducing postoperative complication in stage IV colorectal cancer.

[Comparison of effects of celiac plexus block alone or in combination with retroperitoneal metastatic lymph node injection for pancreatic cancer-related pain].

Objective: To analyze the analgesic effect of CT-guided celiac nerve plexus destruction or celiac plexus destruction combined with absolute ethanol injection on retroperitoneal enlarged lymph nodes in patients with pancreatic cancer with retroperitoneal lymph node metastasis (combined therapy). Methods: Retrospective analysis of clinical data of 187 patients with pancreatic cancer and retroperitoneal lymph node metastasis admitted to Zhengzhou University Cancer Hospital from January 2014 to December 2018 due to poor abdominal pain control. According to the treatment method, they were divided into 2 groups: Group A (n=48) , treated with CT-guided celiac plexus destruction; Group B (n=139) , treated with CT-guided combined therapy. The analgesic effect, morphine application dose, and adverse reactions were compared before surgery, 1 week, 1 month, and 3 months after surgery. Results: The oral morphine doses of patients in Group A before surgery and 1 day, 1 week, 1 month, and 3 months after surgery were (107±34) , (65±23) , (35±12) , (48±18) , (81±25) mg. The oral morphine doses of patients in Group B before surgery and 1 day, 1 week, 1 month, and 3 months after surgery were (112±37) , (53±17) , (27±14) , (42±16) , (63±20) mg. Compared with that before surgery, the oral morphine doses were significantly reduced at 1 day, 1 week, 1 month, and 3 months after surgery in both groups (P<0.05 or P<0.01) . The effective rate and excellent rate of pain treatment in Group A at 1 week after operation were 83.3% and 60.4%, in Group B were 95.7% and 75.5%, respectively. The effective rate and excellent rate of pain treatment in Group A at one month after operation were 71.7% and 45.6%, in Group B were 89.0% and 67.6%, respectively; The effective rate and excellent rate of pain treatment in Group A at three months after operation were 48.6% and 25.7%, respectively, in Group B were 72.6% and 47.0%; Compared with Group A, the effective rate and excellent rate of pain treatment in Group B were increased, and the differences were statistically significant (P<0.05 or P<0.01). There was no significant difference in the incidence of nausea and vomiting between the two groups of patients before and 1 day after surgery, but the incidence of nausea and vomiting at 1 week, 1 month, and 3 months after surgery in Group B was significantly reduced, and the differences were statistically significant (P<0.05 or P<0.01). Compared with that before surgery, the incidence of nausea and vomiting in Group A was significantly reduced at 1 week and 1 month after operation, and the difference was statistically significant (P<0.01); The incidence of nausea and vomiting in Group B was significantly reduced at 1 day, 1 week, 1 month, and 3 months after operation, and the differences were statistically significant (P<0.01). Compared with 1 day after surgery, the incidence of nausea and vomiting in Group A was significantly reduced at 1 week and 1 month after surgery (P<0.05 or P<0.01). The incidence of nausea and vomiting in Group B was significantly reduced at 1 week, 1 month, and 3 months after operation, and the differences were statistically significant (P<0.01). Compared with 1 week after surgery, the incidence of nausea and vomiting in the two groups increased at 3 months after surgery, and the differences were statistically significant (P<0.05 or P<0.01). Compared with 1 month after surgery, the incidence of nausea and vomiting in Group A increased at 3 months after surgery, and the difference was statistically significant (P<0.05). There was no significant difference in the incidence of transient hypotension after surgery in the two groups. The difference in the incidence of postoperative diarrhea was not statistically significant. The incidence was highest within 1 day after surgery and generally recovered within 7 days after surgery. Conclusions: The two schemes can effectively relieve pain in patients with pancreatic cancer with retroperitoneal lymph node metastasis, reduce morphine dose. The combination therapy has higher efficiency and excellent rate, lower morphine dosage after surgery, and lower incidence of nausea and vomiting.

Vasoactive intestinal peptide is required in the maintenance of immune regulatory competency of immune regulatory monocytes.

Dysfunction of the immune regulatory system plays an important role in the pathogenesis of rheumatoid arthritis (RA). Vasoactive intestinal peptide (VIP) has multiple bioactivities. This study aims to investigate the role of VIP in the maintenance of the immune regulatory capacity of monocytes (Mos). Human peripheral blood samples were collected from RA patients and healthy control (HC) subjects. Mos and CD14+ CD71- CD73+ CD25+ regulatory Mos (RegMos) were isolated from the blood samples and characterized by flow cytometry. A rat RA model was developed to test the role of VIP in the maintenance of the immune regulatory function of Mos. The results showed that RegMos of HC subjects had immune suppressive functions. RegMos of RA patients expressed less interleukin (IL)-10 and showed an incompetent immune regulatory capacity. Serum levels of VIP were lower in RA patients, which were positively correlated with the expression of IL-10 in RegMos. In-vitro experiments showed that the IL-10 mRNA decayed spontaneously in RegMos, which could be prevented by the presence of VIP in the culture. VIP suppressed the effects of tristetraprolin (TTP) on inducing IL-10 mRNA decay in RegMos. Administration of VIP inhibited experimental RA in rats through restoring the IL-10 expression in RegMos. RegMos have immune suppressive functions. VIP is required in maintaining IL-10 expression in RegMos. The data suggest that VIP has translational potential in the treatment of immune disorders such as RA.

Cordycepin inhibits cell growth and induces apoptosis in human cholangiocarcinoma.

The purpose of this study was to explore the role of cordycepin in human cholangiocarcinoma (CCA) cell growth and apoptosis. In the present study, colony formation assay, cell-counting kit-8 (CCK-8) assay and tumor xenograft experiment were performed to evaluate the effect of cordycepin on human CCA cell growth in vitro and in vivo; flow cytometric analysis was performed to evaluate the effect of cordycepin on cell apoptosis; quantitative real-time reverse transcription PCR (qRT-PCR) and western blot assays were performed to evaluate the expression levels of Caspase-3, Bcl-2 and Bax. The results showed that cordycepin inhibited cell growth in QBC939 and RBE cells in vitro and it could also inhibit QBC939 cells growth in vivo. Furthermore, the flow cytometric analysis, qRT-PCR and western blot assays showed that cordycepin could trigger QBC939 and RBE cells apoptosis by regulating the expression levels of Caspase-3, Bcl-2 and Bax. And we proposed that cordycepin could inhibit human CCA cell growth in vitro and in vivo, while, this function is related to the induction of cell apoptosis.

Long non-coding RNA MALAT1 promotes cholangiocarcinoma cell proliferation and invasion by activating PI3K/Akt pathway.

Increasing evidence indicated that metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) acted as a key regulator in the proliferation and invasion of several cancers. However, the function of MALAT1 in the development of cholangiocarcinoma has not been experimentally established. In the present study, the expression levels of MALAT1 in cholangiocarcinoma cell lines were detected by quantitative real-time PCR. The effects of MALAT1 knockdown on the cell proliferation and invasion of cholangiocarcinoma cells were detected with Cell Counting Kit-8 (CCK-8), colony formation assay and Trans-well assay, respectively. The expressions of epithelial-mesenchymal transition (EMT)-related proteins (E-cadherin, Vimentin) were evaluated to discover whether the process of EMT was involved. We also evaluated the expression of phos-phatidylinositol-3-kinase/serine/threonine kinase (PI3K/Akt) signaling pathway proteins (PI3K, p-PI3K, Akt, p-Akt) to determine the associated molecular mechanism. And we discovered that MALAT1 was up-regulated in cholangiocarcinoma cancer cells. CCK-8, colony formation and trans-well assay showed that the proliferation and invasion of QBC-939 and RBE with MALAT1 knockdown were inhibited. Moreover, MALAT1 could promote EMT in cholangiocarcinoma cells. In addition, MALAT1 may activate PI3K/Akt pathway. These results indicated that MALAT1 promoted cholangiocarcinoma cell proliferation and invasion. The effects of MALAT1 on cholangiocarcinoma cells might be through activating the PI3K/Akt signaling pathway. These investigations may facilitate a better understanding of MALAT1 and it might be a potential therapeutic target for the treatment of cholangiocarcinoma.

[The progression of parenteral and enteral nutrition based on new guidelines].

As people are getting a better understanding of organism's metabolism and the concept of disease treatment is being continuously updated, parenteral and enteral nutrition become an inter discipline subject that serves for the clinic and involves a number of disciplines. Just in the past five years, related guidelines at home and abroad have been published as much as more than 40. In order to better serve the clinical decision making, this text attempts to give a carding and interpretation from the three aspects of nutrition screening and assessment, the implementing of nutritional intervention and the progress of special nutrition support. It is observed that the standard clinical nutrition diagnosis and treatment process has been formed consensus. But in the practical application, there are still many details need to confirm and further study.

Leptin improves osteoblast differentiation of human bone marrow stroma stem cells.

OBJECTIVE: To study the effects of leptin (LEP) on the osteogenic differentiation of human bone marrow stromal cells (hBMSCs) and to explore the mechanism controlling the process. MATERIALS AND METHODS: Respectively cultivated the third-generation hBMSCs with 100 ng/ml bone morphogenetic protein (BMP) culture media containing 320, 160, 80 and 40 ng/mL LEP, and regular medium. We administered alkaline phosphatase (ALP) dye (on the 7th day) and mineralized nodules alizarin red (on the 21st day) and tested the ALP activity as well as osteocalcin (OCN) level on 7th, 14th, 21st day in each group to establish the best inducing concentration of LEP. 7 days later, we tested bone differentiation related genes expression in the control, 160 ng/mL LEP and 100 ng/mL BMP groups using RT-PCR. RESULTS: The activity of ALP and OCN in the 160 ng/mL LEP group after 7, 14 and 21 days was lower than that of the BMP group but higher than that of other groups. However, LEP significantly promoted the expression of bone differentiation related genes, namely, Cbfal, ALP, COL-I and OCN. CONCLUSIONS: LEP promoted the bone differentiation in hBMSCs by promoting the expression of genes related to bone differentiation.

[Clinical features of multiple myeloma patients with renal insufficiency as the initial clinical manifestation].

OBJECTIVE: To analyze the clinical features of multiple myeloma (MM) with renal insufficiency as the initial manifestation, and to improve the level of clinical diagnosis of MM, and reducing misdiagnosis of this disease. METHODS: To retrospectively analyze the clinical data of 140 patients with MM, who were admitted in our Department of Nephrology and Hematology. They were diagnosed as MM by bone marrow aspiration biopsy. The patients were divided into renal insufficiency group and normal renal function group, based on the criterion of serum creatinine >177 µmol/L. The two groups were statistically analyzed byt test, rank sum test,χ(2) test and binary logistic regression analysis. RESULTS: 55.7% of the patients in the renal insufficiency group presented low level of three immunoglobulin classes (IgG, IgA, IgM), while in the normal-renal function group, 54.3% of patients mainly presented IgG subtype, showing statistically significant differences between the two groups (P<0.001). Univariate analysis showed that IgM level (<0.4 g/L), hemoglobin, white blood cells, erythrocyte sedimentation rate (ESR), total protein, globulin, uric acid, corrected serum calcium, proteinuria and hematuria were statistically significantly different between the two groups (P<0.05 for all). Unconditional logistic regression analysis showed that lower level of IgM (OR=19.992, 95%CI: 1.327-301.202), hemoglobin, uric acid, ESR, serum total protein, proteinuria and hematuria are independent risk factors for the development of renal insufficiency in MM patients (P<0.05 for all). CONCLUSIONS: Low level of IgM (<0.4 g/L) is an important clinical characteristics of MM patients with renal insufficiency as the initial clinical manifestation. For middle-aged and elderly patients, who present as low levels of three IgG classes (IgG, IgA, IgM) or low level of IgM, multiple myeloma should be excluded, so as to reduce the misdiagnosis.

Mercury and cadmium contamination of irrigation water, sediment, soil and shallow groundwater in a wastewater-irrigated field in Tianjin, China.

We investigated the concentrations of Hg, Cd, Pb and As in samples of irrigation water, sediment, soil and groundwater from a field in Tianjin that was irrigated with wastewater. The results showed that the concentrations (Hg, 0.82 microg/L; Cd, 0.18 microg/L; Pb, 1.5 microg/L; As, 8.02 microg/L) in the irrigation water did not exceed the China Surface Water Quality Standard or the maximum concentrations in irrigation water recommended by the FAO. The concentrations of metals in the groundwater of wells (Hg, 0.016 microg/L; Cd, 0.128 microg/L; Pb, 0.25 microg/L; As, 4.65 microg/L) were lower than China Groundwater Quality Standard and the WHO guideline values for drinking water. The groundwater had not yet been contaminated through vertical infiltration-induced leaching. However, a substantial buildup of Hg and Cd in river sediments (I(geo) for Hg and Cd; 5.24 and 3.04, respectively) and wastewater-irrigated soils (I(geo) for Hg and Cd; 2.50 and 3.09, respectively) was observed. Taken together, these results indicated that irrigation with wastewater damaged the soil quality over the long term and that metals more easily accumulated in vegetable fields than rice fields.

Modulation of postoperative immune and inflammatory response by immune-enhancing enteral diet in gastrointestinal cancer patients.

AIM: To evaluate if the administration of an enteral diet supplemented with glutamine, arginine and omega-3-fatty acids modulates inflammatory and immune responses after surgery. METHODS: A prospective randomized double-blind, clinical trial was performed. Forty-eight patients with gastrointestinal cancer were randomized into two groups, one group was given an isocaloric and isonitrogenous standard diet and the other was fed with the supplemented diet with glutamine, arginine and omega-3-fatty acids. Feedings were started within 48 hours after operation, and continued until day 8. All variables were measured before operation and on postoperative day 1 and 8. Immune responses were determined by phagocytosis ability, respiratory burst of polymorphonuclear cells, total lymphocytes lymphocyte subsets, nitric oxide, cytokines concentration, and inflammatory responses by plasma levels of C-reactive protein, prostaglandin E2 level. RESULTS: Tolerance of both formula diets was excellent. There were significant differences in the immunological and inflammatory responses between the two groups. In supplemented group, phagocytosis and respiratory burst after surgery was higher and C-reactive protein level was lower (P<0.01) than in the standard group. The supplemented group had higher levels of nitric oxide, total lymphocytes, T lymphocytes, T-helper cells, and NK cells. Postoperative levels of IL-6 and TNF-alpha were lower in the supplemented group (P <0.05). CONCLUSION: It was clearly established in this trial that early postoperative enteral feeding is safe in patients who have undergone major operations for gastrointestinal cancer. Supplementation of enteral nutrition with glutamine, arginine, and omega-3-fatty acids positively modulated postsurgical immunosuppressive and inflammatory responses.

[Diagnosis and embolization of dural arteriovenous fistulae: report of 18 cases].

In the diagnosis and embolization of 18 patients with dural arteriovenous fistulae (DAVF), we found that they had subarachnoid hemorrhage, exophthalmos and craniocerebral murmur. Angiographically, DAVF was classified in to simple type (9 patients) and complex type (9). A total of 34 embolization procedures were performed in this group. solid particle embolization was used in 31 patients and IBCA embolization in 3. Seven patients were embolized once, 7 twice, 2 four times, and 1 five times. Among them, 7 patients were cured, 9 were improved, and in 1 recurred. DSA is importance in the diagnosis of DAVF. To embolize the entrance of fistulae is the key point of the treatment. This technique is safe and effective. Simple DAVF can be cured by intravascular embolization and the complex one can be cured or improved by multiple embolization.

Kinetics of enzymatic hydrolysis of olive oil in biphasic organic-aqueous systems.

A theoretical model for the lipase-catalyzed hydrolysis of high-concentration olive in biphasic isooctane-aqueous systems has been proposed and confirmed by experiments. The enzymatic reaction of the Michaelis-Menten type that occurred at the interface between organic and aqueous phases was assumed in deriving the rate equations, from which the maximum reaction rate could be obtained by carefully adjusting the volume ratio between the two phases to the optimal value. Equilibrium conversions higher than 98% for 0.1 g/L olive oil in isooctane were attained for systems with volume ratios up to one. Fractions of lipase and lipase-substrate complex adsorbed at the interface increased and seemed to approach to asymptotic values as the rotation speed of impeller increased. Activity of the lipase showed no apparent change between 26 and 37 degrees C, but decrease rapidly with temperature above 43 degrees C. The methodology presented in this work might be used to find kinetic parameters for reactor design and scaleup.