Microflora extensively exist in the environment and are closely related to our health.Intestinal microflora have been concerned greatly,and have a profound effect on regulating the immune environment,metabolism and host physiological function.The purpose of this review was to describe the new progress of intestinal microflora on immune function and disease pathogenesis in recent years.

Objective Acute gastrointestinal dysfunction (AGD) is a common problem in critically ill patients, for whomearly enteral nutrition ( EN) is widely used, but its application dosage remains controversial.This study aimed to observe the influence of dif-ferent doses of early EN on acute gastrointestinal tolerance, new infections and other complications, inflammation indexes, and prognosis in AGD patients. Methods We selected 120 critically ill patients that met thecriteria of class-ⅡAGD and needed EN support andequal-ly randomized them intoa standard-dose and a low-dose ENgroup.The former group received EN at 20 mL/h, with an addition of 10 mL/h every 12 hours according to the tolerance and supplemented byparenteral nutrition (PN) to achieve the target calories(60%) on the 3 rd day, while the latterat 20 mL/h for 7 days, supplemented by PN to achieve the target calories on the 3 rd day and from the 7 th day gradu-ally increased to the full volume.We recorded the patients′ICUdays, hospitaldays, mortality rate, organ function support days, incidence of feeding intolerance within 7 days, incidence of new infections within 7 and 28 days, and levels of C-reactive protein (CRP), procalci-tonin (PCT), tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) and compared these indexes between the two groups. Resulst There were no statistically significant differences between the low -and standardd-ose EN groups in the patients′ICU days, hospital days, mortality rate,organ function support days, or incidence of new infections within 7 and 28 days ( P>0.05) .The incidence of feeding intol-erance on the 7 th day was significantly lower in the low-dose than in the standard-dose EN group ( 13.3 vs 36.7%, P<0.05).On the 1st, 3rd, and 7 th day, the level of CRP was (5.90±0.72), (16.52± 3.09) , and ( 32.11 ±4.33 ) ng/L, respectively, in the low-dose groupversus(5.83±0.59), (15.83±1.19), and (33.16±4.51)ng/L in the standard-dose group, while that of PCTwas (4.71±1.25), (10.63± 2.21), and ( 16.89±3.39) ng/mL, respectively, in the former versus (4.55±0.67), (10.41±1.99), and (17.49±3.87)ng/mL in the latter, both increased in a time-dependent manner and with significant differ-ences among the three time points within the same group ( P<0.05) .The levels of TNF-αand IL-6 were elevated in the same manner and also with significant differences among the three time points within the same group ( P<0 .05) . Conc lusion Lowdose of early enteral nutrition can improve the feeding tolerance of AGDpatients, but does not influence the incidence of new infections and prognosis.

Objective To detect the differential expression genes(DEGs)between Barrettg esophagus(BE)and normal esophagus with oligomicroarray,and to explore the target genes related to the development of BE.Methods The total RNAs of matched BE and normal esophagus mucosa from saIne patient were isolated with one step Trizol method.Matched RNAs were qualified with 10g/L agarose gel electrophoresis.After tRNA purification,cRNAs were synthesized and labeled with fluorescence.which were tIlen hybridized with Agilent oligomicroarray containing 30,968 probes.The fluorescence intensity features were detected by Agilent scanner and quantified by software Feature Extraction.Results On average,2 biopsies by disposable jumbo biopsy forceps provided approximately 5μg RNA required for microarray.The total RNA,reverse transcription product and fluorescence labeled cRNA were all of high quality.Among 2-fold DEGs,there were 142 up-regulated genes and 284 down-regulated genes including 15 bel-2 related genes such as bel-2,MCL1,BAX,BIK and BCLAF1 Conclusion Microarray-based studies are feasible in endoscopically obtained tissues.The development of BE is a complicated process involving multi-genes,in which abnormal expression of bel-2 family related genes might be involved,but the exact mechanism needs further research.

Objective To evaluate cytotoxic effects of cytokine-induced killer cells (CIK cells) transfected with the interleukin-2 (IL-2) gene on malignant melanoma cells.Methods Mouse spleen cells were extracted,lymphocyte cells were separated,and CIK cells were prepared from these lymphocyte cells.PEGF-N1 plasmids containing IL-2 gene (PEGF-NI-IL-2) were transfected into CIK cells.Fluorescence microscopy was used to observe transfection products,and reverse transcriptase-polymerase chain reaction (RT-PCR) was conducted to determine the IL-2 mRNA expression.Then,effector cells such as CIK cells and IL-2-transfected CIK cells were separately co-cultured with target cells (B16 melanoma cells) at effector-target ratios of 10∶ 1,20∶1 and 40∶1,then 4-hour lactate dehydrogenase release assay was performed to evaluate cytotoxic effects of the two kinds of CIK cells on B 16 cells.After effector cells were cocultured with target cells at the effector-target ratio of 40∶1 for 48 hours,enzyme-linked immunosorbent assay (ELISA) was conducted to detect levels of IL-2,interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) in the supernatant of the two kinds of CIK cells.Finally,mouse models of melanoma were established,and a total of 28 melanoma-bearing mice were divided into 4 groups to be peritumorally injected with 0.2 ml sodium chloride physiological solution (control group),100 IU IL-2 solution (IL-2 group),CIK cell suspension at a cell density of 1 × 106 cells per milliliter (CIK group) and IL-2-transfected CIK cell suspension at a cell density of 1 × 106 cells per milliliter (IL-2-transfected CIK group) respectively.Tumor morphology,tumor inhibition rate and cell apoptosis rate were used to evaluate tumor growth in the above groups.If data were normally distributed,t-test was used for comparing means between two groups,and analysis of variance and least significant difference (LSD)-t test were used for comparing means among multiple groups.Results Fluorescence microscopy and RT-PCR both showed that IL-2 was successfully transfected into CIK cells.The cytotoxic effect of IL-2-transfected CIK cells on B16 cells was strongest at the effector-target ratio of 40:1.Levels of IL-2,IFN-γ and TNF-α were also significantly higher in the supernatant of IL-2-transfected CIK cells [(1107.26 ± 6.49) pg/ml,(50.01 ± 3.35) pg/ml,(39.86 ± 3.25) pg/ml] than those in that of CIK cells [(51.09 ± 3.85) pg/ml,(32.71 ± 2.43) pg/ml,(30.11 ± 3.08) pg/ml,t =442.60,14.93,6.89,all P ＜ 0.01].Animal experiments showed that the tumor volume obviously increased in the control group (P ＜ 0.05),but significantly decreased in the IL-2 group,CIK group and IL-2-transfected CIK group (all P ＜ 0.001) after intervention compared with those before intervention.Furthermore,the tumor volume in the IL-2-transfected CIK group was significantly less than that in the other three groups (all P ＜ 0.01),but no significant difference was observed between the IL-2 group and CIK group (P ＞ 0.05).In addition,the apoptosis rate was significantly higher in the IL-2 group,CIK group,and IL-2-transfeeted CIK group than that in the control group (all P ＜ 0.01).The apoptosis rate and tumor inhibition rate were significantly higher in the IL-2-transfected CIK group than those in the IL-2 group and CIK group (all P ＜ 0.01),but insignificantly different between the IL-2 group and CIK group (P ＞ 0.05).Conclusion IL-2-transfected CIK cells had stronger killing effects on malignant melanoma.

Objective To investigate the cognitive difference between uni-modal (V,A) and bi-modal (VA)target stimuli from both vision and audition,and then to study the neural mechanisms of bi-modal enhancement.Methods This experiment adopted a speeded target stimuli detection task, both behavioral and electroencephalographic responses to uni-modal and bi-modal target stimuli which were combined from visual and auditory target stimuli,were recorded from 14 normal subjects using a 64-channel EEG NeuroScan system.The differences of cognitive between uni-modal and bi-modal stimulus were tested from both behavioral (reaction time (RT) and error rate (ER)) and event-related potentials (ERPs) (P2 latency and amplitude,P3 latency and amplitude)data,and the correlation between behavioral and ERPs results were analyzed.Results As a result,the RT,ER and P3 latency has significant difference between uni-modal and bi-modal target stimuli.In addition,there were significant correlation between behavioral data and P3 latency,especially from the RT and P3 latency.Conclusion By comparing the difference between uni-modal and bi-modal from both behavioral and ERPs results,we could reached the conclusion that the neural mechanism of bi-modal target detection was predominant over that of vision and audition uni-modal target detection,the enhancement take place not only involved in early ERP components (such as P1 and N1),but engaged at the late ERP components (such as P2 and P3).

OBJECTIVETo report on the result of thalassemia screening and genetic diagnosis for pregnant women from Guiyang region.

METHODSPrenatal screening for thalassemia was carried out based on erythrocyte parameters and hemoglobin electrophoresis. Single-tube multiplex GAP-PCR and PCR-reverse dot blot hybridization were performed on suspected cases to identify common alpha- and beta- thalassemia mutations, and direct sequencing was used for identifying rare mutations.

RESULTSAmong 13 738 pregnant women, 1745 (12.70%) were suspected as thalassemia. In terms of native place, the provinces with highest screening-positive rates were Guangxi, Guangdong, Jiangxi and Guizhou. And the ethnic groups with highest screening-positive rates were Zhuang, Li, and Buyi. Among 801 women subjected to genetic testing, 457 (57.05%) were diagnosed with thalassemia. In total 9 genotypes of alpha- thalassemia were detected, with the most common genotypes being --/alpha alpha (63.35%), - alpha/alpha alpha (19.37%) and - alpha/alpha alpha (8.90%). Eleven genotypes of beta- thalassemia were detected, with the most common genotypes being CD17/N (42.91%), CD41-42/N (32.46%) and IVS-II-654/N (11.94%). Two cases were detected with rare beta-thalassemia mutations (CD54-58/N and IVS-I-130/N).

CONCLUSIONThe screening-positive rate of thalassemia among pregnant women in Guiyang region is relatively high. The rates have shown substantial difference in terms of native place and ethnic group. Thalassemia-related mutations in Guizhou region have a diverse spectrum, which showed certain difference from those of other regions.

Adolescent ; Adult ; Female ; Genotype ; Humans ; Middle Aged ; Pregnancy ; Prenatal Diagnosis ; methods ; Thalassemia ; genetics ; Young Adult

OBJECTIVEThe three-dimensional (3D) structure of left atrial appendage (LAA) in atrial fibrillation patients were reconstructed by Mimics 3D imaging system, aiming at guiding for selection of both the size and location of the closure devices and making preliminary risk assessment of LAA closure with Watchman system.

METHODSInclusion criteria were: ten voluntary patients with both atrial fibrillation and indication for LAA closure aging from 40 to 85 years old with contraindication for oral anticoagulants or unwillingness to take long-term oral anticoagulation therapy from May to December 2014. 3D reconstruction of LAA was preoperatively made by Mimics 3D imaging system. With the Mimics 3D reconstruction model and the results of both transesophageal echocardiography (TEE) and LAA radiography, the size and location for the closure device were chosen. The devices were planted at the ostium of the LAA.

RESULTSTen atrial fibrillation patients were enrolled (average age: (66.3±11.9) years old) and all successfully implanted with the Watchman LAA closure devices. Nine of them were with non-valvular atrial fibrillation with average CHADS2-VAS score (3.2±1.7) and HAS-BLED score (2.7±1.6). The rest one was a valvular atrial fibrillation patient with the history of the percutaneous balloon mitral valvuloplasty (PBMV) without surgical indications of mitral valve replacement (MVR). There was no blood leakage around the device by regular postoperative TEE and LAA radiography examinations. There were no complications of bleeding, embolism, or stroke through both at peri-operative period and at 1 month follow-up post procedure.

CONCLUSIONPreoperative Mimics 3D reconstruction of LAA by Mimics 3D imaging system among atrial fibrillation patients provides essential information guiding the successful LAA closures.

Adult ; Aged ; Aged, 80 and over ; Anticoagulants ; Atrial Appendage ; surgery ; Atrial Fibrillation ; surgery ; Cardiac Surgical Procedures ; Contraindications ; Echocardiography, Transesophageal ; Embolism ; Humans ; Imaging, Three-Dimensional ; Middle Aged ; Prostheses and Implants ; Prosthesis Implantation ; Stroke ; Treatment Outcome

Objective To analyze the epidemiological characteristics of patients with sea lice injury in coastal baths in Qinhuangdao City, and provide scientific evidence for the importance of prevention of sea lice injury and the early warning of sea lice outbreak. Methods The data of 2 659 patients with sea lice injury, including gender, age composition, severity of bruises and other epidemiological data reported by the coastal bathing stations in Qinhuangdao City from 2016 to 2018 (mainly from July to August) were retrospectively analyzed, and the correlation between the temperature at the surface of sea water and the number of patients with sea lice injury was also analyzed. Results Among the 7 bathing beaches along the coast of Qinhuangdao City, Dongshan Bathing Spot (1 101 cases) and Repulse Bay Bathing Beach (1 365 cases) had the largest numbers of bruises, while the Gold Coast Bath had the least (only 5 cases), and the differences in number of bruises in different baths were statistically significant in 2016, 2017, 2018 years (277, 1 890, 492 cases respectively, χ2= 490.611, P < 0.05). Among 2 659 patients, 1 124 were children (≤14 years old), 1 535 were adult, 1 570 male and 1 089 female patients. The severity type of patients' sea lice injury in each bath was mainly mild to moderate type; among the total injury cases, there were 2 589 cases with mild type injury accounting for 97.37%, 61 cases with moderate type (2.29%) and 9 cases with severe type (0.34%). A linear trend between sea surface temperature and the patients' number of bruises was seen, and there was a positive correlation between the sea surface temperature and the patients' number (r = 0.433, P < 0.05). Conclusion The sea lice injuries in Qinhuangdao City are mainly distributed in the Dongshan and Repulse Bay Baths, the main type of injury is light one, and in the mean time the injury is influenced by factors such as popularization of science, medical care, environmental factors, and collective sea lice drift, etc.

Objective:To investigate the effect of neoadjuvant chemotherapy on locally advanced rectal cancer.Methods:After collecting the clinical data of 180 rectal cancer patients diagnosed initially as cT3-4N0-2M0 stage, patients were divided into neoadjuvant chemotherapy group, neoadjuvant chemoradiotherapy group and control group. First-line chemotherapy regimen CAPEOX was used as neoadjuvant therapy. Second-line chemotherapy regimen FOLFIRI was used for the patients not sensitive to CAPEOX . Long-term radiotherapy (total dosage: 45-50 Gy)was used in the neoadjuvant chemoradiotherapy group. The compliance, anastomotic fistula , infection and incidence of anal dysfunction, effective rate of neoadjuvant therapy and tumor reduction rate were observed.Results:The compliance of neoadjuvant treatment was higher than that of the control group(90% vs.85% vs.73%, χ 2=6.16, P<0.05); The rate of adverse reaction in neoadjuvant chemoradiotherapy group was higher than that in the neoadjuvant chemotherapy group and control group(28% vs.6% vs.12%, χ 2=10.57, P<0.05); The anastomotic fistula(17% vs. 6% vs. 5%, χ 2=6.95, P<0.05), infection rate(16% vs. 5% vs. 3%, χ 2=6.89, P<0.05)and incidence of anal dysfunction(21% vs. 9% vs.7%, χ 2=6.42, P<0.05) in neoadjuvant chemoradiotherapy group were higher than that in the neoadjuvant chemotherapy group and control group. There was no significant difference between the neoadjuvant chemotherapy group and the control group( P>0.05) .Overall effective rate in neoadjuvant chemotherapy group and neoadjuvant chemoradiotherapy group was 40 % and 66%, respectively. Conclusions:Patients with locally advanced rectal cancer have better compliance with neoadjuvant chemotherapy and lower toxic side effects compared to neoadjuvant chemoradiotherapy. Neoadjuvant chemotherapy can be safely and effectively used in locally advanced rectal cancer.

Objective:To verify the clinical safety and efficacy of new intelligent ventilation mode adaptive minute ventilation (AMV)+IntelliCycle ventilation in patients with mild-to-moderate acute respiratory distress syndrome (ARDS).Methods:The patients with mild-to-moderate ARDS, admitted to intensive care unit (ICU) of the First Affiliated Hospital of Jinzhou Medical University from February 2018 to February 2019, were enrolled in the study. The patients were divided into synchronous intermittent mandatory ventilation+pressure support ventilation (SIMV+PSV) group and AMV+IntelliCycle group according to the random number table method. All patients were given mechanical ventilation, anti-infection, analgesia and sedation, nutritional support and symptomatic treatment of primary disease after admission. SV800 ventilator was used for mechanical ventilation. In the AMV+IntelliCycle group, after setting the minute ventilation volume (VE), inhaled oxygen concentration (FiO 2) and positive end expiratory pressure (PEEP), the ventilator was turned on the full-automatic mode, and the preset value of VE percentage was 120%. In the SIMV+PSV group, the ventilator parameters were set as follows: the ventilation frequency was 12-20 times/min, the inspiratory expiratory ratio was 1∶1-2, the peak inspiratory pressure (PIP) limit level was 35-45 cmH 2O (1 cmH 2O = 0.098 kPa), and the setting of FiO 2 and PEEP was as the same as that of AMV+IntelliCycle group, the triggering flow was set to 2 L/min. All of the clinical parameters between the two groups were compared. The main outcomes were duration of mechanical ventilation, ventilator alarm times, manual operation times, and the mechanical power; the secondary outcomes were respiratory rate (RR), VE, tidal volume (VT), PIP, mouth occlusion pressure (P0.1), static compliance (Cst), work of breathing (WOB), and time constant at 0, 6, 12, 24, 48, 72, and 120 hours; and the blood gas analysis parameters of patients before and after ventilation were recorded. Results:A total of 92 patients with mild-to-moderate ARDS were admitted during the study period, excluding those who quit the study due to death, abandonment of treatment, accidental extubation of tracheal intubation and so on. Eighty patients were finally enrolled in the analysis, with 40 patients in SIMV+PSV group and AMV+IntelliCycle group respectively. ① Results of main outcomes: compared with the SIMV+PSV mode, AMV+IntelliCycle ventilation mode could shorten the duration of mechanical ventilation (hours: 106.35±55.03 vs. 136.50±73.78), reduce ventilator alarm times (times: 10.35±5.87 vs. 13.93±6.87) and the manual operations times (times: 4.25±2.01 vs. 6.83±3.75), and decrease the mechanical power (J/min: 12.88±4.67 vs. 16.35±5.04, all P < 0.05). But the arterial partial pressure of carbon dioxide (PaCO 2) of AMV+IntelliCycle group was significantly higher than that of SIMV+PSV group [mmHg (1 mmHg = 0.133 kPa): 41.58±6.81 vs. 38.45±5.77, P < 0.05]. ② Results of secondary outcomes: the RR of both groups was improved significantly with the prolongation of ventilation time which showed a time effect ( F = 4.131, P = 0.005). Moreover, compared with SIMV+PSV mode, AMV+IntelliCycle mode could maintain a better level of RR, with intervention effect ( F = 5.008, P = 0.031), but no interaction effect was found ( F = 2.489, P = 0.055). There was no significant difference in VE, PIP, P0.1 or Cst between the two groups, without intervention effect ( F values were 3.343, 2.047, 0.496, 1.456, respectively, all P > 0.05), but they were significantly improved with the prolongation of ventilation time in both groups, with time effect ( F values were 2.923, 12.870, 23.120, 7.851, respectively, all P < 0.05), but no interaction effect was found ( F values were 1.571, 1.291, 0.300, 0.354, respectively, all P > 0.05). The VT, WOB or time constant in both groups showed no significant changes with the prolongation of ventilation time, and no significant difference was found between the two groups, there was neither time effect ( F values were 0.613, 1.049, 2.087, respectively, all P > 0.05) nor intervention effect ( F values were 1.459, 0.514, 0.923, respectively, all P > 0.05). Conclusion:AMV+IntelliCycle ventilation mode can shorten the ventilation time of patients with mild-to-moderate ARDS, reduce mechanical power, and reduce the workload of medical care, but PaCO 2 in the patients with AMV+IntelliCycle mode is higher than that in the patients with SIMV+PSV mode.