Cancer cachexia is a complex multifactorial disease that can lead to significant reduction of skeletal muscle mass. MicroRNAs (miRNAs) are non-coding RNAs that are closely related to the development of cancer cachexia muscle atrophy. Studies have shown that miRNAs play an important role in the occurrence and development of cancer cachexia muscle atrophy by regulating various signaling pathways, but the mechanism by which miRNAs mediate cancer cachexia muscle atrophy has not been fully clarified. A systematic investigation of the role of miRNAs in cancer cachexia muscle atrophy may provide useful references for the precise treatment of patients with cancer cachexia muscle atrophy.

Objective To analyze the status of occupational hazards in key positions of the small and micro book and newspaper printing enterprises in Beijing City. Methods A total of 16 small and micro printing enterprises in Beijing City were selected as the research subjects using the judgment sampling method. The status of occupational hazard was assessed using on-site occupational health investigations. The volatile chemical components in organic solvents such as inks and cleaning agents used in the workplace, the level of chemical hazardous agents in the air, and noise intensity were detected and analyzed. Results A total of 1 105 workers from 16 small and micro printing enterprises were included. The occupational hazard exposure rate was 22.2% (245/1 105), with chemical hazardous agents and noise exposure rates of 13.5% and 22.2%, respectively. The rate of compliance with occupational health training among the head of the enterprise and the occupational health management personnel, the regular detection rate of occupational hazards in last year, and the rate for the occupational health examination in last year were both 100.0%. The rate for annual update of occupational hazard project reporting was 93.8% (15/16). The usage rates of gas mask and noise-proof earplug were 68.8% (11/16) and 50.0% (8/16), respectively. The effectiveness rates of anti-toxic and noise-reduction facilities were 87.5% (14/16) and 62.5% (10/16). The sign setting rates of chemical hazardous agents and noise warning were 93.8% (15/16). Acetone and isopropanol were found in ink and cleaning agents in 15 printing enterprises, while toluene, xylene, and ethylbenzene were found in three, two, and one enterprise, respectively. Benzene, 1,2-dichloroethane, n-hexane, and trichloroethylene were not found in all 16 enterprises. Both the exposure concentration of short term and exposure concentration of time weighted average of the above chemical hazards were lower than the lower limit of quantitation of the detection method in the workplace and work site air among the 16 printing enterprises, and none of concentration was exceeded the national standard. A total of 240 noise work sites were detected, and the national noise-exceeding rate was 11.2%(27/240). Conclusion Noise hazards are prominent in the small and micro printing enterprises in Beijing City, and attention should be paid to the prevention and protection of noise-exposure. The usage rate of personal protective equipment is not high, and the training and on-site supervision management of protective equipment wearing in workers should be strengthened.

Bone metastasis of lung cancer is relatively common in patients with advanced lung cancer, the treatment research of which has been made remarkable progress. In terms of systemic therapy, chemotherapy is the traditional treatment plan; targeted therapy shows strong efficacy in treating lung cancer patients with specific gene mutations; immunotherapy can bring new treatment options for lung cancer patients with bone metastasis by activating the body's immune system, which can be used alone or in combination with other therapies. Anti bone metastasis drugs such as bisphosphonates and denosumab play an important role in reducing bone destruction and bone-related adverse events. In terms of local therapy, radiotherapy can accurately irradiate tumor lesions and relieve pain symptoms; surgical treatment is suitable for specific bone metastasis to restore bone stability and function. In addition, analgesic treatment and psychological intervention can alleviate patients' pain and anxiety. These therapeutic advances bring new hope to patients with lung cancer bone metastasis.

The occurrence rate of primary liver cancer in malignant tumors ranks sixth in the world, and the mortality rate ranks third, with a poor prognosis and a five-year survival rate of less than 5%. Most patients with liver cancer in China are found to be in the intermediate and advanced stages, and a targeted immunotherapy combination has become the main treatment option. However, many patients have underlying liver lesions, and their liver function cannot meet the requirements of targeted immunotherapy, which directly affects the treatment of liver cancer patients. Therefore, it is very important to optimize the patient's liver function in a timely manner so as to obtain the opportunity for anti-tumor therapy. This article reviews the current status and response strategies before liver injury related to targeted immune therapy in patients with primary liver cancer.

The emergence of immune checkpoint inhibitors holds new promise for patients with small cell lung cancer. Studies have found that PD-L1 expression, tumor mutation burden, genomic characteristics, peripheral blood parameters and other indicators can be used as prognostic predictors in patients with small cell lung cancer receiving immunotherapy. Further exploration and evaluation of relevant predictors can provide a reference for screening patients with potential benefits of immunotherapy.

Objective:To analyze the clinicopathological features and prognosis of idiopathic membranous nephropathy (IMN) in children, and to investigate the factors influencing their prognosis.Methods:The clinical and pathological data of 128 children with IMN hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2019 were retrospectively analyzed.They were divided into 2 groups according to the pathological manifestations: group A[typical membranous nephropathy(MN) group] and group B (atypical MN group), and the clinicopathological characteristics of the 2 groups were compared.Different treatment regimens and their efficacy were summarized, and the prognosis and its influencing factors were analyzed.The primary endpoint event at follow-up was the occurrence of end stage renal disease (ESRD), and the secondary endpoint event was the occurrence of renal insufficiency.Children with IMN were further divided into endpoint event group and non-endpoint event group according to the presence or absence of endpoint events at the last follow-up.Survival analysis was performed using the Kaplan-Meier survival curve method.The Cox proportional risk model method was used to analyze the factors influencing the prognosis of poor kidney outcomes in children with IMN. Results:(1)A total of 128 children were included, with the male-to-female ratio of 1.13∶1.00.The median age of onset and peak age of onset were 13.0 (10.3, 15.0) years, and 12-16 years (68.8%), respectively.Massive proteinuria was detected in 119 cases (93.0%), including 103 cases (80.5%) with massive proteinuria and hematuria, 4 cases(3.1%) with simple hematuria, and 5 cases (3.9%) with non-renal proteinuria.There were 29 cases (22.7%) in group A and 99 cases (77.3%) in group B. (2)Blood triacylglycerol level was significantly higher in group B than that of group A[2.1 (1.5, 3.0) mmol/L vs.1.7(1.1, 2.5) mmol/L], while high-density lipoprotein[1.5(1.1, 1.8) mmol/L vs.1.8(1.4, 2.1) mmol/L], serum albumin[22.0(17.0, 27.3) g/L vs.25.5 (21.0, 32.5) g/L] and complement C3[(1.1±0.2) g/L vs.(1.2±0.2) g/L] were significantly lower in group B than those of group A (all P<0.05). (3)Complete clinical data during hospitalization and follow-up data were obtained from 91 children with IMN, with a median follow-up time of 87.0 (49.0, 104.5) months.Among them, 5 cases (5.5%) progressed to ESRD, involving 3 cases received renal transplantation, and 9 cases (9.9%) had secondary endpoints.Cumulative renal survival rate for ESRD at 5 and 10 years were 96.2% and 92.9%, respectively, which, for the secondary endpoints at 5 and 10 years were 95.2% and 84.8%, respectively.(4)Kaplan-Meier survival analysis showed no significant difference in the cumulative renal survival between group A and group B ( P>0.05). Multifactorial Cox regression analysis showed that tubular atrophy/interstitial fibrosis was an independent risk factor for renal insufficiency in children with IMN ( HR=0.102, 95% CI: 0.011-0.940, P<0.05). Conclusions:Massive proteinuria combined with hematuria is the major clinical manifestation of IMN in children, and atypical MN is the major pathological manifestation.Tubular atrophy/interstitial fibrosis is an independent risk factor for renal insufficiency in children with IMN.

Pancreatic cancer is one of the fatal malignant tumors, and its dense stroma, which accounts for 90% of the volume of pancreatic tumor, is the main reason for the low survival rate of pancreatic cancer. Cancer-associated fibroblasts (CAFs) are an important group of cells in the tumor stroma of pancreatic cancer, and activated CAFs induce a strong connective tissue interstitial reaction and secretes a variety of soluble molecules to remodel the extracellular matrix, thereby forming a microenvironment that helps with the proliferation, invasion, and metastasis of pancreatic cancer. At present, an increasing number of evidence has shown that CAFs play an important role in the drug resistance of pancreatic cancer, especially in chemotherapy and immunotherapy, and CAFs result in a low response rate of pancreatic cancer treatment by interfering with the metabolism of antitumor drugs, participating in the signaling pathways associated with drug resistance, and forming an immunosuppressive microenvironment. This article elaborates on the specific mechanism of CAFs participating in the drug resistance of pancreatic cancer from the two aspects of chemotherapy and immunotherapy, in order to provide new ideas for identifying new therapeutic targets for pancreatic cancer and improving the response rate of pancreatic cancer treatment.

Objective:To investigate the efficacy and safety of plasma exchange(PE) in the treatment of autoimmune hemolytic anemia in children.Methods:The data from 8 hospitals in China during November 2014 to April 2017 were collected, and the clinical characteristics of PE in children with AHA were analyzed retrospectively.Results:A total of 21 children with AHA were included in the study, including 17 cases from PICU and 4 cases from pediatric kidney ward, with 11 boys and 10 girls, and the median age was 3.64(0.25, 11.10)years old, and median hospital stay was 12(4, 45)days.There were 15 cases(71.4%) with infection, 2 cases(9.5%)with autoimmune diseases, 4 cases(19.0%) with unknown.Consciousness disturbance occurred in 4 patients before replacement and recovered to normal after PE.The volume of blood decreased in two cases(9.5%) and completely relieved.There were 20 cases of anemia (95.2%), 15 cases were normal after PE, and 5 cases were improved.Jaundice occurred in 18 cases (85.7%), 12 cases were normal after PE, 6 cases were improved.Hepatosplenomegaly was found in 11 cases, 10 cases were normal after PE, 1 case was improved.After PE, the hemoglobin and red blood cell count increased, while the total bilirubin, indirect bilirubin, urea nitrogen and lactate dehydrogenase decreased, there were significant differences between pre-and post-replacement ( P<0.05). Only 1 case had allergic reaction, which was improved after symptomatic treatment, and PE was continued.After PE, 2 cases (9.5%) had complete remission, 16 cases (76.2%) had partial remission and 3 cases (14.3%) had been discharged. Conclusion:PE therapy can obviously improve the clinical symptoms and laboratory indexes of children with AHA who have failed to respond to conservative treatment.It can be used as a treatment measure for children with severe AHA and has a good safety.

Objective:To investigate the risk factors, clinical features and prognosis of abnormal liver function after receiving oxaliplatin-containing chemotherapy regimen in patients with colorectal cancer, and to provide a relevant basis for clinical diagnosis and treatment.Methods:The clinical data of 108 colorectal cancer patients who received XELOX (oxaliplatin+capecitabine) or mFOLFOX6 (oxaliplatin+leucovorin+ 5-fluorouracil) chemotherapy regimen from October 2017 to May 2019 in the First Hospital of Shanxi Medical University were analyzed retrospectively. According to the liver function indexes after chemotherapy, the patients were divided into abnormal liver function group and normal liver function group. The observation indexes included alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, alkaline phosphatase, γ-glutamyl transpeptidase. The clinical characteristics of liver dysfunction after oxaliplatin-containing chemotherapy were analyzed and the related factors that might lead to liver dysfunction were analyzed by using multivariate logistic regression analysis.Results:Among 108 patients receiving chemotherapy, there were 67 (62.0%) cases of abnormal liver function. The main grades of liver dysfunction were grade 1 and grade 2, including 49 cases of grade 1 (73.1%) and 16 cases of grade 2 (23.9%). After chemotherapy, the abnormal liver function usually began in 1-4 cycles, of which 22 cases were 1 cycle (32.8%), 17 cases were 2 cycles (25.4%), 20 cases were 3 cycles (29.8%), and 4 cases were 4 cycles (6.0%). Univariate analysis showed that the age <60 years old, chemotherapy cycle >6, the use of mFOLFOX6 regimen, unprotected hepatoprotective drugs were related to liver dysfunction ( χ2 values were 3.910,4.799, 12.861, 4.044; all P < 0.05). Multivariate logistic regression analysis showed that mFOLFOX6 regimen and unprotected hepatoprotective drugs were independent risk factors of abnormal liver function ( HR = 3.405, 95% CI 1.266-9.159, P = 0.015; HR = 2.348, 95% CI 1.012-5.477, P = 0.047). Conclusions:For patients with colorectal cancer who have a high risk of liver dysfunction after chemotherapy, it is recommended to prefer XELOX regimen among oxaliplatin-containing chemotherapy regimens and to take preventive liver protection treatment.

Immunotherapy is a new anti-tumor method. The application of immune checkpoint inhibitor greatly improves the survival benefit for patients, but the drug resistance of immunotherapy affects the efficacy. Therefore, it is very important to explore the mechanism of drug resistance and solve the problem of drug resis-tance in tumor immunotherapy. Hypoxia in tumor microenvironment is the key factor of immune drug resistance. Hypoxia can inhibit the immune cells function and lead to immune escape through various mechanisms. It can be the breakthrough for overcoming the immunotherapy drug resistance that blocking pathway of hypoxia to promote immune resistance. By reviewing the mechanism of immunotherapy drug resistance induced by hypoxia, it is helpful to explore the development prospect of hypoxia-inducible factor-1α (HIF-1α) related targeted drugs in clinical application for immunotherapy.