Objective:To investigate the effect of colonoscopy on intestinal microecology in healthy adults of different ages and its therapeutic strategy.Methods:A total of 128 healthy officers and soldiers of different ages and retired military personnel who underwent physical examination in the Outpatient Department of Chinese PLA Medical School from May 1, 2020 to December 30, 2020 were selected as the research subjects. They were divided into young people group (Group Y, 18 to 35 years old, n=37), middle-aged people group (Group M, 36 to 59 years old, n=44), and elderly people group (Group E, 60 years old or above, n=47) according to their age. Another 110 elderly research subjects were divided into placebo group (Control Group, n=36), Brewer’s yeast group (Yeast Group, n=35) and Bacillus subtilis combined with Enterococcus faecium group (Combined Group, n=39) according to the treatment methods. Fecal samples were collected 1 day before intestinal preparation for colonoscopy, 7 days, and 14 days after colonoscopy, respectively, and the abundance, diversity, and composition of intestinal microflora were detected by 16S rRNA sequencing technology. Steady-state changes and adverse symptoms of intestinal microflora in the elderly research subjects after treatment were observed. Results:Before intestinal preparation, there was no statistically significant difference among the three age groups in the abundance of intestinal microflora ( P>0.05); on the 7th day after colonoscopy, the abundance was all decreased significantly; on the 14th day after colonoscopy, the abundance of the Group Y and the Group M could recover to the levels before intestinal preparation, while that of the Group E was not completely recovered ( P<0.05). Compared with the 14th day after colonoscopy, there was no statistically significant difference in the diversity of intestinal microflora among the three age groups before the colonoscopy ( P>0.05). Compared with before intestinal preparation and the 14th day after colonoscopy, the diversity on the 7th day after colonoscopy was significantly decreased ( P<0.05). Regarding the phylum level, there was no statistically significant difference in the composition of microflora between the Group Y and the Group M before intestinal preparation ( P>0.05). The proportion of Firmicutes in the Group E was slightly lower than those in the Groups Y and M, while the proportion of Bacteroides was higher ( P<0.05). Regarding the family level, compared with the 14th day after colonoscopy, there was no statistically significant difference in the composition of bacteria in the Groups Y and M before intestinal preparation ( P>0.05). Compared with before intestinal preparation, the numbers of trichospiraceae in the three age groups on the 7th day after colonoscopy were all significantly decreased ( P<0.05), while the numbers of enterobacteriaceae were significantly increased ( P<0.05). The abundance of Lactobacillus in the Group E was higher than those in the Groups Y and M at three time points ( P<0.05). The abundance of intestinal microflora in the Yeast Group and the Combined Group were significantly higher than that of the Control Group. The clustering trends of the Yeast Group, the Combined Group, and the Control Group were significantly different at different treatment stages. The incidence of adverse symptoms in the Combined Group and the Yeast Group was significantly lower than that of the Control group ( P<0.05). Conclusion:Colonoscopy can cause imbalance of intestinal microbiota homeostasis, and the elderly have a longer recovery time and suffer from more complications. Probiotics can help them quickly recover intestinal microbiota homeostasis and reduce the incidence of complications.

Objective:To investigate the effect of colonoscopy on intestinal microecology in healthy adults of different ages and its therapeutic strategy.Methods:A total of 128 healthy officers and soldiers of different ages and retired military personnel who underwent physical examination in the Outpatient Department of Chinese PLA Medical School from May 1, 2020 to December 30, 2020 were selected as the research subjects. They were divided into young people group (Group Y, 18 to 35 years old, n=37), middle-aged people group (Group M, 36 to 59 years old, n=44), and elderly people group (Group E, 60 years old or above, n=47) according to their age. Another 110 elderly research subjects were divided into placebo group (Control Group, n=36), Brewer’s yeast group (Yeast Group, n=35) and Bacillus subtilis combined with Enterococcus faecium group (Combined Group, n=39) according to the treatment methods. Fecal samples were collected 1 day before intestinal preparation for colonoscopy, 7 days, and 14 days after colonoscopy, respectively, and the abundance, diversity, and composition of intestinal microflora were detected by 16S rRNA sequencing technology. Steady-state changes and adverse symptoms of intestinal microflora in the elderly research subjects after treatment were observed. Results:Before intestinal preparation, there was no statistically significant difference among the three age groups in the abundance of intestinal microflora ( P>0.05); on the 7th day after colonoscopy, the abundance was all decreased significantly; on the 14th day after colonoscopy, the abundance of the Group Y and the Group M could recover to the levels before intestinal preparation, while that of the Group E was not completely recovered ( P<0.05). Compared with the 14th day after colonoscopy, there was no statistically significant difference in the diversity of intestinal microflora among the three age groups before the colonoscopy ( P>0.05). Compared with before intestinal preparation and the 14th day after colonoscopy, the diversity on the 7th day after colonoscopy was significantly decreased ( P<0.05). Regarding the phylum level, there was no statistically significant difference in the composition of microflora between the Group Y and the Group M before intestinal preparation ( P>0.05). The proportion of Firmicutes in the Group E was slightly lower than those in the Groups Y and M, while the proportion of Bacteroides was higher ( P<0.05). Regarding the family level, compared with the 14th day after colonoscopy, there was no statistically significant difference in the composition of bacteria in the Groups Y and M before intestinal preparation ( P>0.05). Compared with before intestinal preparation, the numbers of trichospiraceae in the three age groups on the 7th day after colonoscopy were all significantly decreased ( P<0.05), while the numbers of enterobacteriaceae were significantly increased ( P<0.05). The abundance of Lactobacillus in the Group E was higher than those in the Groups Y and M at three time points ( P<0.05). The abundance of intestinal microflora in the Yeast Group and the Combined Group were significantly higher than that of the Control Group. The clustering trends of the Yeast Group, the Combined Group, and the Control Group were significantly different at different treatment stages. The incidence of adverse symptoms in the Combined Group and the Yeast Group was significantly lower than that of the Control group ( P<0.05). Conclusion:Colonoscopy can cause imbalance of intestinal microbiota homeostasis, and the elderly have a longer recovery time and suffer from more complications. Probiotics can help them quickly recover intestinal microbiota homeostasis and reduce the incidence of complications.

BACKGROUND: In recent years, immune checkpoint inhibitors (ICIs) have become a hot spot in cancer because of their remarkable survival benefits on non-small cell lung cancer (NSCLC) patients. However, the immune-related adverse events (ir-AEs) induced by ICIs have been frequently reported due to its specificity and severity. This article is to summarize and evaluate ir-AEs induced by ICIs. Hopefully it can provide guidance for advanced NSCLC patients treatment options, early recognition and management of ir-AEs. METHODS: Randomized controlled trials (RCT) which involved ICIs in the treatment of advanced NSCLC were retrieved in the Cochrane Libraby, PubMed, EMBASE and other databases. The primary outcome includes the incidence, grade and organ specificity of ir-AEs. Relative risk (RR) was used as the effect size, which was expressed as 95% confidence interval (CI). The Stata 15.0 and RevMan 5.3 software are used to conduct the meta analysis. RESULTS: A total of 17 RCTs were included. The ir-AEs were generally more than those in the traditional chemotherapy group. The risk and severity of ir-AEs induced by ICIs combined group were generally higher than that of ICI monotherapy, while the incidence of severe ir-AEs induced by ICIs combination therapy was similar to that of anti-cytotoxic T-lymphocyte-asscociated antigen 4 (CTLA-4) group. CONCLUSIONS ICIs have different toxicity profile compared with chemotherapy, and their immune-related toxicity is stronger than that of traditional chemotherapy. ICIs induced ir-AEs is organ-specific, and different ICI has specific immune-related toxicity profiles. As ICIs represent a new and distinct class of treatment for NSCLC, this article has systematically illustrated the efficacy and ir-AEs induced by ICIs, hopefully it can be useful for clinicians and patients to get a further understanding of ICIs, and facilitate early prediction, comprehensive diagnosis, and prompt management of ir-AEs by providing status reference and management suggestions, so that ICI can bring more benefit for advanced NSCLC patients.