The ecological balance of intestinal microbiota plays an important role in digestion,absorp-tion,metabolism,immunity and protection against pathogens.Intestinal microbiota can not only regulate the innate immunity of the body,but also can stimulate the immune response by the bacteria itself and its metabo-lites.The imbalance intestinal microbiota may lead to abnormal immune mechanism,and then participate in the occurrence and development of the tumor,especially colorectal cancer.

The tumor microenvironment is closely related to the occurrence and development of tumor. Hypoxia is considered to be one of the most important factors in tumor microenvironment.Formation of hypoxic microenvironment can be found in most of malignant tumors,which can inhibit the anti-tumor immune response. Recent studies have indicated that immunosuppressive cells,tumor stem cells and circulating tumor cells in hypoxic tumor microenvironment can mediate immune suppression and immune tolerance,and then promote development of tumor.The new immune therapy will focus on normalizing tumor vasculature,reconstructing the tumor microenvironment,avoiding immune suppression and averting tumor immune tolerance.

Objective To investigate the prognostic implications of the size of left atrium with catheter ablation of atrial fibrillation.Methods Forty-two consecutive patients with symptomatic and drug-refractory paroxysmal or persistent AF admitted from 2005 May to 2006 November were included in the present study.The mean age was 60?12 years and 25 patients(58%)were male.Paroxysmal AF was present in 37 patients(88%)and persistent AF in 5 patients(12%).A 3D electroanatomic map of the LA including the pulmonary vein(PV)ostia was constructed with a nonfluoroscopic navigation system(Carto,Biosense Webster).The left and right PVs were encircled by continuous radiofrequency ablation lines.The left atrial diameter(LAD)was measured by 2D-guided M-mode echocardiography,in terms of anteroposterior diameter,left-right diameter and superior-inferior diameter by ”Simpson” method.Left atrial volume(LAV)was calculated by ”Pumbo” method.Body surface area(BSA)(m2)was used for indexing body size variables.The respective formulae are:left atrial volume index(LAVI)=LAV/BSA(mL/m2);left atrial diameter index(LADI)=LAD/BSA.Results Fifteen patients(34%)suffered from recurrent AF after 3 months of follow up.The LAVI of the recurrent group of patients was(68.19?23.68)mL/m2 compared with that of the non-recurrent group of(52.07?17.34)ml/m2(P=0.019).Logistic regression analysis revealed LAVI was the only independent risk factor of recurrence(OR=1.04,95% CI 0.99-1.09,P=0.04).Age(P=0.806),sex(P=0.338),AF history(P=0.46),hypertension(P=0.963),LAD(P=0.41),LADI(P=0.093),LAV(P=0.471),LVEF(P=0.91)between the 2 groups had no statistic differences.Conclusion Left atrial volume index(LAVI)is a better parameter compared with LAD,LADI and LAV in reflecting the left atrial size.LAVI is an independent predictor of recurrence of AF after catheter ablation.We found that LAVI≥55 mL/m2 was the strongest predictor,independent of age and other clinical parameters.

Objective The aim of this study was to investigate the mechanisms and the possible treatment of early and frequent recurrence of atrial fibrillation after segmental pulmonary veins isolation (PVI) in patients with paroxysmal atrial fibrillation (AF). Methods and Results Guided by Lasso mapping catheter, segmental pulmonary veins isolation was performed using radiofrequency energy in 54 consecutive patients (mean age 53?15 years) with recurrent documented symptomatic paroxysmal AF. Early recurrence of AF and rapid atrial arrhythmia occurred in 10 out of 54 patients (18.5%) within two weeks after PVI. 4 out of 10 patients (7.4 %) experienced early and frequent recurrence of atrial fibrillation and atrial tachyarrhythmia, which we termed as “atrial arrhythmic storm". The 4 patients were treated with class Ⅰ and Ⅲ antiarrhythmic drugs for 3 months. The “atrial arrhythmic storm" subided apparently and disappeared within two weeks after antiarrhythmic drug therapy. Only 1 patient still suffered from paroxysmal AF after drug control at mean follow-up of 3 months. After repeat ablation, there was no occurrence of AF and atrial arrhythmia in this patient.Conclusion A few paroxysmal atrial fibrillation patients experienced “atrial arrhythmic storm" after segmental pulmonary veins isolation. It is suggested that “atrial arrhythmic storm" after PVI may due to a lot of factors and combined antiarrhythmic drug therapy may be feasible. Early repeat ablation in patients with “atrial arrhythmic storm" may not be necessary.

Objective To evaluate the clinical value of 12-lead Holter monitoring for coronary heart disease (CHD) patients with inferior myocardial ischemia. Methods Ninety-six patients with CHD had accepted coronary angiography (CAG) and 12-lead Holter examination. Results The sensitivity for detecting inferior myocardial ischemia in 12-lead Holter monitoring was 64.91%, the specificity 53.85%, and the positive detecting value 67.20%. In 12-lead Holter monitoring, inferior myocardial ischemia was recorded in 20% of only RCA lesion group, and in 70.37% of double -vessel lesion group, and in 80% of three-vessel lesion group.Conclusion 12-lead Holter monitoring is of some value to evaluate the inferior myocardial ischemia in CHD patients, but other clinical data should be considered.

Objective To investigate the clinical and pathological characteristics of patients with chronic hepatitis B virus(HBV)infection in immune tolerant phase.Methods Ninety-eight chronic HBV carriers in immune tolerant phase were enrolled in this study.The age,gender,serum HBV DNA level,hepatic inflammatory activity and fibrosis,hepatic HBsAg and HBcAg expressions were analyzed.The grade of inflammatory activity and stage of fibrosis were also compared in patients with different levels of serum alanine aminotransferase(ALT).Data analysis was done by chi-square test. Results In 98 patients,83(84.7%)were＜30 years old and 15(15.3%)were≥30.Patients whose mother was HBsAg positive were 48.0%.High levels of serum HBV DNA were found in all patients, with 78.5% were＞1×107 copy/mL.Only 5 cases(5.1%)were G0 of the inflammatory grade;whereas,64 cases(65.3%)were G1,29(29.6%)were G2.There were 56 patients(57.1%)had no significant liver fibrosis;and 23 cases(23.5%)were S1,14(14.3%)were S2,5(5.1%)were S3;none of patients had cirrhosis.The HBsAg and HBcAg in liver tissues were positive in 79(80.6%)and 80(81.6%)cases,respectively.The fibrosis stages of patients with higher ALT levels were significantly greater than patients with lower ALT levels(X2=8.112 3,P=0.043 7).Conclusions Most of patients with chronic HBV infection in immune tolerant phase present mild inflammation in liver,some of them have already developed fibrosis.Therefore,liver pathology is recommended for these patients to help understand the patients' conditions and make correct therapeutic decisions.

To explore the relationship between brachial ankle artery pulse wave velocity of the (baPWV) in different estimation GFR (eGFR) groups and atherosclerosis.In 2010,2012 and 2014,eGFR and baPWV were detected in 1 427 healthy persons.As eGFR level decreased,baPWV increased accordingly with higher proportion of baPWV ≥1 400 cm/s.The percentage of eGFR lower than 60 ml · min-1 · 1.73 m-2 was similar in subgroups with different baPWV.However,the proportion of eGFR reduction ≥ 30％ decreased according to the elevation of baPWV.Multivariate logistic regression analysis indicated the lower the eGFR,the higher the risk of atherosclerosis.Low eGFR is an independent risk factor for atherosclerosis.

Objective To explore the relationship between the change in waist circumference (WC) and new onset diabetes (NOD) in a population of north China.Methods A total of 101510 subjects took part in the health examination from 2006 to 2007 for the employees of Kailuan Group.89364 subjects with fasting plasma glucose (FPG) ＜7.0 mmol/L,no history of diabetes,with complete data of FPG and WC,and without taking hypoglycemic agents were sclected as the observation cohort.Subjects who did not participate in the health examination from 2010 to 2011 and had incomplete data were finally excluded and thus 58426 subjects were included for final analysis.According to the baseline WC measurement and its quartile in the health examination during 2006 to 2007,the observed population was divided into two groups (obese group and non-obese group) or four groups ( first,second,third,and forth quartile groups).Multiple logistic regression analysis was used to test the relation between the change in WC and NOD.Results ( 1 ) The incidence of NOD in obese group was higher than that in non-obese group (8.02％ vs 3.37％,P＜0.01 ).Along with increasing WC in the 4 quartile groups,the incidence of NOD was progressively increased,being 2.32％,3.62％,5.46％,and 8.89％ respectively in the total population ( 2.84％,3.65％,5.32％,and 8.95％ in male,and 1.50％,3.41％,6.22％,and 8.51％ in female).( 2 ) Multiple logistic regression analysis showed that compared with the first quartile group,the second,third,and forth quartile groups had increased risks of NOD after adjusting age,gender,and other risk factors,the OR value being 1.17,1.47,and 1.95,respectively.After adjusting above factors in different genders,the influence of the second group on NOD in males and females was not significant,however,they still increased the risks of NOD,with the OR value being 1.08,1.36,and 1.90 in male,and 1.35,1.70,and 1.88 in female,respectively.Conclusion The incidence of NOD is increased with increasing WC.

Objective To explore the role of default mode network (DMN) in the pathophysiology of depression and the correlations between the functional connectivity (FC) of DMN and the clinical characteristics of depression through the resting-state fMRI scan in depressed patients. Methods Sixteen medication-na?ve patients with major depressive disorder and 15 healthy controls were recruited and underwent the resting-state MRI scan. Hamiliton depression rating scale (HAMD) was used to evaluate patients’symptom. The FC of DMN and its correlations with clinical features of pa-tients were analyzed. Results Compared with healthy controls, the FC within DMN in depressed patients is disturbed. There were negative correlations between the left mPFC-left hippocampus FC and HAMD total scores (r=-0.569, P=0.021) and subscale scores for sluggishness (r=-0.498, P=0.050). The left mPFC-right hippocampus FC in patients was negatively correlated with HAMD scores (r=-0.508, P=0.045). There were negative correlations between FC in the hippo-campus and HAMD subscale scores for cognitive impairment (r=-0.509, P=0.044). Conclusions The results suggest that there is abnormal FC within DMN in drug-na?ve patients with depression during resting state and some abnormal altera-tions of FC may be correlated with the clinical characteristics in depression.

Objective:To analyze the clinicopathological characterization of primary esophageal benign tumor (EBT). Methods:A total of 1,058 EBTs were enrolled from 500,000 cases in an esophageal and cardiac tumor biological sample and clinical information data-base of Henan Key Laboratory for Esophageal Cancer Research (1973-2015) in the First Affiliated Hospital of Zhengzhou University. SPSS 21.0 software was applied for data analysis. Results:In this database, 1,058 cases with primary EBTs among the 249,246 esopha-geal tumor patients with detailed clinical and pathological information were identified with an incidence of 0.42%(1,058/249,246). A total of 544 patients were male with an average age of 50±11 years old, whereas 514 patients were female, with an average age of 52± 11 years old. Among the 10 types of EBTs, leiomyoma was the most common type (84.50%, 894/1,058), followed by papilloma (6.90%, 73/1058). Adenoma (0.38%, 4/1,058) was the rarest type. Leiomyoma, gastrointestinal stromal tumor, and neurofibroma mainly oc-curred in male patients. By contrast, lipoma, granulosa cell tumor, schwannoma, and hemangioma mainly occurred in female patients.All five cases of hamartoma occurred only in female patients. Given the incidence of≥50%as the common standard, the common EBT in sequence in young male patients was leiomyoma and gastrointestinal stromal tumor, whereas that in young female patients was granulosa cell tumor and lipoma. The common EBT in sequence in older male patients was papilloma, gastrointestinal stromal tumor, and leiomyoma, whereas that in older female patients was schwannoma, papilloma, leiomyoma, gastrointestinal stromal tumor, and hamartoma. Additionally, lipoma, hemangioma, neurofibroma, and adenoma in male patients and neurofibroma in female patients oc-curred in older patients. The different ages of patients with EBTs (P=0.034) and leiomyoma (P=0.004) had a statistical significance. In these EBTs, leiomyoma, papilloma, gastrointestinal stromal tumor, and schwannoma mainly occurred in the middle esophagus, where-as lipoma mainly occurred in the lower esophagus. The major treatment for EBT in the present study was surgery (57.54%, 492/855), which was followed by endoscopic resection (38.01%, 325/855) and others (4.45%, 38/855). Conclusion:The incidence of EBT is low, with a couple of different histological types. Gender, age, and predilection sites are different depending on the histological types of EBTs. Surgery and endoscopic resection are the major treatment methods.