Advances in the role of gut microbiota in the regulation of the tumor microenvironment (Review).

As a protector of human health, the gut microbiota plays an important role in the development of the immune system during childhood, and the regulation of dietary habits, metabolism and immune system during adulthood. Dysregulated gut flora is not pathogenic, but it can weaken the protective effect of the immune system and cause various diseases. The tumor microenvironment is a physiological environment formed during tumor growth, which provides nutrients and growth factors necessary for tumor growth. As an important factor affecting the tumor microenvironment, the intestinal microflora affects the development of tumors through the mechanisms of gut and microflora metabolites, gene toxins and signaling pathways. The present article aimed to review the components and mechanisms of action, clinical applications, and biological targets of gut microbiota in the regulation of the tumor microenvironment. The present review provides novel insights for the future use of intestinal flora, to regulate the tumor microenvironment, to intervene in the occurrence, development, treatment and prognosis of tumors.

Research Progress of CircRNAs Regulating Biological Behavior of Clear Cell Renal Cell Carcinoma / 肿瘤防治研究

Renal cell carcinoma is one of the ten multiple cancers, and its incidence rate and mortality rate have been increasing in more than 20 years. Clear cell renal cell carcinoma (ccRCC) is the most common histopathological subtype. Cyclic ribonucleic acids (circRNAs) are noncoding ribonucleic acids, which are widely distributed with diverse cellular functions and have organ- and tissue-specific expression patterns. Recent studies have shown that circRNAs are abnormally expressed in ccRCC and play an important role in the occurrence and development of ccRCC. However, there are few researches and related mechanisms of circRNAs regulating the biological behavior of ccRCC. Therefore, the paper mainly describes the research progress of circRNAs regulating the biological behavior of ccRCC and discusses its potential as a biomarker for early diagnosis and prognosis of ccRCC and targeted therapy.

Progress in the Regulation of PI3K/AKT/mTOR Signaling Pathway by Ursolic Acid in Colorectal Cancer / 世界科学技术-中医药现代化

Ursolic acid (UA) is an active pentacyclic triterpenoid widely found in grass, leaves, flowers and fruits of plants, which is antioxidant, antimicrobial, anti-inflammatory, hepatoprotective, immunomodulatory, anti-tumor, chemopreventive, cardioprotective and antihyperlipidemic and hypoglycemic. In paper, the ursolic acid structure, antitumor mechanism, PI3K/AKT/mTOR signaling pathway taking part in the process of colorectal cancer, and the regulation of PI3K/AKT/mTOR signaling pathway by ursolic acid in stopping the development of colorectal cancer was summarized.

Efficacy and safety of nalbuphine on analgesia of patients in intensive care unit / 中华危重病急救医学

Objective To analyze the efficacy and safety of nalbuphine in patients with sedative analgesia in intensive care unit (ICU). Methods A prospective observation was conducted. The adult patients with mild and moderate analgesia in general ICU of the First Affiliated Hospital of Zhengzhou University from January to November in 2017 were enrolled, and they were divided into nalbuphine group and sufentanil group in proper order. The nabobrown group was given 40 mg nabobrown, the sufentanil group was given 0.1 mg sufentanil, both of which were injected with 50 mL normal saline for continuous intravenous infusion in micro-pump. Infusion speed was checked according to pain level. The analgesic target was critical-care pain observation tool (CPOT) score < 2. The change in hemodynamics of patients in both groups were observed, and CPOT score and Richmond agitation-sedation scale (RASS) score were recorded before and l, 3, 5, 12, 24 hours after administration. The analgesic and sedative effects of two drugs were evaluated. Results A total of 141 patients were enrolled, including 71 patients in nalbuphine group and 70 in sufentanil group. There was no significant difference in general data including gender, age, body weight, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) or pain source, as well as baseline hemodynamics parameter between the two groups. At 1 hour and 3 hours after administration, nalbuphine had no effect on blood pressure, but the heart rate was decreased slightly, while the heart rate and blood pressure of the sufentanil group were decreased obviously. The two drugs could make the heart rate and blood pressure fluctuate obviously with the time of medication, but there was no statistical difference between the two drugs. The two drugs had no significant effect on pulse oxygen saturation (SpO2) during analgesia. The average dosage of nalbuphine was 0.03 (0.02, 0.05) mg·kg-1·h-1in the nalbuphine group, and the patient was satisfied with the analgesic effect until 3 hours after the use of the drug, and CPOT score was significantly decreased as compared with that before administration [1.0 (1.0, 2.0) vs. 3.0 (2.0, 4.0), P < 0.01], and the sedative effect was increased, RASS score was significantly lower than that before administration [0 (0, 1.0) vs. 1.0 (1.0, 2.0), P < 0.01]. No patients in naporphine group were treated with sufentanil due to unsatisfactory analgesia. The average dosage was 0.11 (0.06, 0.14) μg·kg-1·h-1in the sufentanil group, the patient was satisfied with the analgesic effect until 5 hours after administration, and the CPOT score was significantly lower than that before administration [1.0 (1.0, 2.0) vs. 4.0 (3.0, 6.0), P < 0.01], and the sedative effect was significantly increased, RASS score was significantly lower than that before administration [0 (-1.0, 0) vs. 2.0 (1.0, 2.0), P < 0.01]. The scores of CPOT and RASS in the sufentanil group were significantly higher than those of the naporphine group before use, so the decrease in the CPOT and RASS scores of the two drugs was further analyzed, which indicated the decrease in CPOT score of naporphine group was significantly lower than that in sufentanil group from 3 hours on [1.0 (0, 2.0) vs. 2.0 (1.0, 3.0), P < 0.05], and the decrease in RASS score of naporphine group was significantly lower than that in sufentanil group from 1 hour on [0 (0, 1.0) vs. 1.0 (0, 2.0), P < 0.01]. It suggested that naporphine could achieve sustained and stable analgesic effect and avoid excessive sedation caused by sufentanil. Conclusions Naporphine had a sustained and stable analgesic effect on patients with mild and moderate ICU analgesia. The onset time of naporphine was equivalent to sufentanil, and it had a certain sedative effect and less influence on hemodynamics.

Significance of serum human HE4 and CA 125 for diagnosis of epithelial ovarian cancer / 国际检验医学杂志

Objective To evaluate the value of HE4 ,CA125 in the diagnosis of epithelial ovarian cancer (EOC) .Methods A to‐tal of 54 samples with epithelial ovarian cancer ,64 suspicious benign pelvic mass ,and 60 health controls were consecutively enrolled in this study .Results Good diagnostic performance in discriminating benign from EOC patients was obtained for CA125 and HE4 . Serum level of HE4 of the patients in the three group were 189 .94 pmol/L ,56 .74 pmol/L and 46 .36 pmol/L .Levels of CA125 were 89 .39 U/L ,45 .11 U/L and 34 .24 U/L .There were stastically significant differences between the groups(P<0 .05) .The ser‐um HE4 and CA125 levels of the patients with ovarian cancer at stage Ⅲ ,Ⅳ(HE4=236 .25 pmol/L ,CA125=206 .35 U/L) were significantly higher than the cases at stage Ⅰ ,Ⅱ(HE4=96 .36 pmol/L ,CA125=67 .8 U/L P<0 .05) .Benign pelvic mass as con‐trol ,the specificity (SP) was 86 .6% ,sensitivity (SN) was 82 .6% ,positive predictive value and negative predictive value of the ser‐um HE4 were 85 .71% ,71 .67% ,73 .84% ,and 84 .31% respectively .SN of CA125 was 86 .67% ,higher than that of HE4 (71 .67% ,P<0 .01) .The area under curves (AUC) of HE4 was 0 .87 higher than that of CA125 (0 .81) ,(P<0 .01) .Combing de‐tection of ovarian cancer was higher than that of HE4 and CA125 alone .SP was 95 .15% ,negative predictive value was 92 .13%(P<0 .01) .Conclusion Overall ,the level of serum CA125 and HE4 increase significantly ,which showes well diagnostic perform‐ance to EOC from benign diseases .The combined detection of CA125 and HE4 could improve the diagnostic power in cervical cancer prominently ,so it has great reference value in the diagnosis of epithelial ovarian cancer .

The clinical and neuroimage features of Non-alcoholic Wernicke's encephalopathy / 中国神经精神疾病杂志

Objective Objective The present study was to increase the awareness of nonalcoholic Wernicke's encephalopathy ( WE) to reduce its misdiagnosis.Methods The clinical features and MR imaging findings in 6 patients with nonalcoholic WE were retrospectively analyzed.Results All patients exhibited different degrees of unconsciousness.Only two patients presented with the typical triad of neuro-ophthalmologic manifestations, ataxia, and global confusion.All patients presented with typical MR features characterized by bilaterally altered signal of the medial thalamus, periventricular region of the third ventricle and periaqueductal area. In addition, two patients developed symmetric cortical and facial nerve nucleus involvements with deep coma, which was clinically rare.The average clinical recovery and MRI imaging recovery times were 7.5 months and 2.8 months, respectively,.Two patients with deep coma showed a poor prognosis:1 patient died, and the other had a sever spastic paralysis of her extremities and mental retardation during a follow -up of 2 years.Two patients with deep coma showed symmetric hyperintensities on diffusion -weighted imaging ( DWI) .Conclusions MRI images are useful in the early diagnosis of nonalcoholic WE.Cortical and cranial nerve nucleus involve-ment in nonalcoholic WE patients may be an indication of irreversible damage and a poor prognosis.In addition, hyperintensities on DWI may also indicate an unfavorable prognosis.

Effect of Pharmaceutical Care on the Efficacy of Senior Patients with Chronic Obstructive Pulmonary / 中国药师

Objective:To discuss the therapeutic effect of pharmaceutical care for old patients with chronic obstructive pulmonary disease ( COPD) . Methods:Totally 192 patients diagnosed as COPD were randomly divided into 2 groups according to a random num-ber table, 100 cases in the experimental group and 92 cases in the control group. The control group was treated with the conditional therapy, and the experimental group was treated with pharmaceutical care additionally. The studieds on COPD assessment test ( CAT) , modified British medical research council ( mMRC) and the value of pulmonary function index ( FEV1% index) were carried out and compared between the two groups. Results:There was no statistically significant difference in the CAT score, mMRC classification and FEV1% index between the two groups on admission (P>0. 05), however, after the treatment, the CAT score and mMRC classifica-tion were decreased and FEV1% index was increased in the two groups, and there was statistical significance between them ( P <0. 05). The CAT score and mMRC classification in the experimental group were lower and FEV1% index was higher than that in the control group(P<0.05). Compared with the medication errors(n=13, 14.13%) and incidence of adverse drug reactions(n=5, 5. 43%) in the control group, the medication errors(n=2, 2. 0%) and incidence of adverse drug reactions (0%) in the experimental group were significantly decreased. Conclusion:Clinical pharmacists provide effectively pharmaceutical care, which can significantly improve the clinical therapeutic efficacy in old patients with COPD.

Protective Effect of Silymarin on Kidneys of Rats with Type 2 Diabetic Nephropathy / 中国药师

Objective:To evaluate the efficacy of silymarin on type 2 diabetic nephropathy in rats. Methods:Totally 60 male al-bino Wistar rats at the age of 8 weeks were involved in the study, and non-insulin-dependent diabetes mellitus was induced in 45 over-night-fasted rats by intramuscular injection of streptozotocin and nicotinamide. Among the 45 rats, three ones failed to make the model, and forty-two rats with diabetic nephropathy were randomly divided into diabetes control group (DC group), diabetes treated by low dosage silymarin group ( DT-L group) and diabetes treated by high dosage silymarin group ( DT-H group) with 14 cases in each. The dosage of silymarin in DT-L group and DT-H group was 60 mg·kg-1 ·d-1 and 120mg·kg-1 ·d-1 , respectively, and the treatment course was 60 days. The other 15 rats were divided into the normal control group ( NC group) with equal volume buffer solution. The glycosylated hemoglobin, urine volume, serum creatine, serum uric acid, and urine albumin levels were analyzed by the semi-automat-ic biochemial analyzer. Results:At the end of the study, the DC group had significantly higher levels of blood glucose, glycosylated hemoglobin, urine volume, serum uric acid and urine albumin than the NC group (P<0. 05), while the two silymarin-treated groups showed significantly lower levels of the indices than the DC group (P<0. 05). Conclusion:The results show that silymarin has pro-tective effect on kidneys of rats with type 2 diabetes mellitus, which lay foundation for the future clinical application.

The correlation research of the levels of CA-125 antigen and vascular endothelial growth factor in serum and peritoneal fluid in patients with endometriosis / 中国医师进修杂志

Objective To explore the changes of the levels of CA-125 antigen(CA125) and vascular endothelial growth factor (VEGF) in serum and peritoneal fluid in patients with endometriosis (EMT), and the relationship with EMT. Methods One hundred and twenty patients with EMT (EMT group)and 98 patients with uterine fibroids (control group) were enrolled in this study. The levels of CA125 and VEGF in serum and peritoneal fluid were detected by enzyme linked immunosorbent assay (ELISA), and the results were compared. Results The levels of serum CA125,VEGF in EMT group were significantly higher than those in control group:(40.31±11.14) kU/L vs.(24.71±9.19) kU/L,(59.75±6.87) ng/L vs. (36.38±8.12) ng/L, there were significant differences(P0.05). The levels of peritoneal fluid CA125,VEGF in EMT group were significantly higher than those in control group:(311.46± 107.29) kU/L vs.(158.17± 55.42) kU/L,(73.28 ±10.40) ng/L vs. (40.21 ±9.84) ng/L, there were significant differences (P<0.05). The levels of peritoneal fluid CA125,VEGF in Ⅲ-Ⅳ phase were significantly higher than those in Ⅰ-Ⅱ phase in EMT group:(387.41±70.91) kU/L vs. (308.42±81.21) kU/L, (69.22±7.13) ng/L vs. (55.44±8.23) ng/L, there were significant differences (P<0.05). In EMT group, the levels of CA125 and VEGF in serum were significantly lower those in peritoneal fluid:(40.31±11.14) kU/L vs. (311.46±107.29) kU/L, (59.75±6.87) ng/L vs. (73.28 ±10.40) ng/L, there were significant differences (P<0.05). Conclusions The levels of CA125 and VEGF in serum and peritoneal fluid are closely related to EMT. Peritoneal fluid in monitoring of EMT may be more sensitive and reliable than serum.

Lipoprotein (a) and homocysteine potentiate the risk of coronary artery disease in male subjects / 中国医师进修杂志

Objective To discuss the rehtionship between lipoprotein [Lp (a)],homocysteine (Hcy) and coronary artery disease (CAD) in men.Methods Two hundred and twenty-two male patients admitted for coronary angiography were classified into CAD positive group (111 cases) and CAD negative group (111 cases).The clinical data and plasma Hcy and Lp(a) levels were recorded in both groups.Logistic regression analysis was used to analyze males CAD risk factors.Results Lp (a) ≥0.3 g/L was a risk factor for CAD (OR =5.04,95％ CI 1.88-13.51,P =0.001),whereas Hcy was not related to CAD (OR =1.35,95％ CI 0.63-2.89,P =0.443).However,when both factors were considered together in an interaction model,plasma high Hcy and high Lp (a) levels were risk factors for CAD (OR =11.54,95％ CI 2.62-45.61,P=0.003).Conclusion Plasma Lp (a) and Hcy levels may increase the incidence of male CAD process.

Research on the management of large-scale instruments in medical schools / 中国医学装备

Objective: To analyze the present situation of the management of large-scale instruments in a medical school and give some reasonable suggestions. Methods: Through the research on the use of 85 large-scale instruments in our university, we tried to find out the methods of improving the utilization ratio of large-scale instruments. Results:There are many reasons of the poor management and low utilization rate of large-scale instruments in medical schools. Conclusion: Taking some measures could effectively improve the utilization rate of large-scale instruments in medical schools, such as simplifying the working procedure, solving the operating and repair expenses, strictly controlling argumentation, drawing up scientific evaluation and incentive measures and so on.