Paclitaxel (PTX), a valuable natural product derived from Taxus species, exhibits remarkable anti-cancer properties. It penetrates nanopores in microtubule walls, interacting with tubulin on the lumen surface and disrupting microtubule dynamics, thereby inducing cytotoxic effects in cancer cells. PTX and its derivatives have gained approval for treating various diseases due to their low toxicity, high efficiency, and broad-spectrum application. The widespread success and expanding applications of PTX have led to increased demand, raising concerns about accessibility. Consequently, researchers globally have focused on developing alternative production methods and applying nanocarriers in PTX delivery systems to enhance bioavailability. This review examines the challenges and advancements in PTX sourcing, production, physicochemical properties, anti-cancer mechanisms, clinical applications, trials, and chemo-immunotherapy. It aims to provide a comprehensive reference for the rational development and effective utilization of PTX.
Humans ; Paclitaxel/pharmacology* ; Antineoplastic Agents, Phytogenic/pharmacology* ; Neoplasms/drug therapy* ; Animals ; Taxus/chemistry*

ObjectiveTo determine the syndrome of a rat model of follicular dysplasia induced by Tripterygium glycosides based on prescriptions and investigate the mechanism of traditional Chinese medicine intervention via the adenosine monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin （mTOR）/hypoxia-inducible factor-1 （HIF-1）/vascular endothelial growth factor （VEGF） pathway. MethodForty-eight rats with regular estrous cycles were randomly assigned into a normal group （n=8） and a modeling group （n=40）. The rats in the modeling group were administrated with Tripterygium glycoside suspension （75 mL·kg^-1） by gavage for 30 days. The modeled rats were assigned into model， Siwutang （3.69 g·kg^-1）， Youguiyin （3.11 g·kg^-1）， Zuoguiyin （7.29 g·kg^-1）， and Guishenwan （10.35 g·kg^-1） groups， with 8 rats in each group. The drug intervention lasted for 14 days. The changes of estrous cycle were detected by Pap staining， and a stereoscope was used to observe the morphology of the ovarian tissue. Hematoxylin-eosin staining was employed to observe the pathological changes and follicle count in the ovarian tissue. Enzyme-related immunosorbent assay （ELISA） was used to measure the levels of follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， and estradiol （E₂） in the serum. Real-time fluorescence quantitative polymerase chain reaction and Western blot were employed to determine the mRNA and protein levels， respectively， of AMPK， mTOR， HIF-1， and VEGF in the ovarian tissue. ResultCompared with the normal group， the model group had a disordered estrous cycle， reduced secondary and mature follicles， increased atretic follicles， elevated FSH and LH levels， lowered E₂ level， up-regulated mRNA and protein levels of AMPK， and down-regulated mRNA and protein levels of mTOR， HIF-1， and VEGF （P<0.01）. Compared with the model group， Guishenwan increased secondary and mature follicles， decreased atretic follicles， lowered the FSH and LH levels， elevated the E₂ level， down-regulated the mRNA and protein levels of AMPK， and up-regulated the mRNA and protein levels of mTOR， HIF-1， and VEGF （P<0.01）. Compared with Guishenwan group， Siwutang， Youguiyin， and Zuoguiyin decreased mature follicles， increased atretic follicles （P<0.01）， elevated the LH （P<0.01） and FSH （P<0.05） levels， and lowered the E₂ level （P<0.05）. In addition， Youguiyin up-regulated the protein level of AMPK （P<0.05） and down-regulated the mRNA levels of mTOR and HIF-1 （P<0.01） as well as the mRNA and protein levels of VEGF （P<0.01）. Siwutang down-regulated the mRNA levels of mTOR and HIF-1 as well as the mRNA and protein levels of VEGF （P<0.05）. Zuoguiyin down-regulated the mRNA level of mTOR and the protein and mRNA levels of VEGF （P<0.05）. ConclusionGuishenwan may improve the ovarian function and promote follicle maturation in a rat model of follicular dysplasia by inhibiting the AMPK/mTOR/HIF-1/VEGF pathway， with the therapeutic effect superior to Zuoguiyin， Youguiyin， and Siwutang. It was hypothesized that this model presented the syndrome of kidney-essence deficiency.

Objective To explore the effectiveness of ADDIE instruction model(Analyse,Design,Develop,Implement,Evaluate)in the on-the-job training for neonatal transfer nurses to improve the comprehensive ability in life-saving as well as to ensure the safety of neonates during the transfer.Methods The pre-and post-control study in self-trained comparison was conducted with 35 neonatal nurses in our hospital.Thirty-five neonatal nurses in our hospital were included in a special training group for neonatal transport.According to the ADDIE instruction model,the training needs of nurses were analysed,special training protocols were designed and developed,training rules were implemented and the effects of training on the nurses were evaluated.Scores in professional theoretical knowledge,practical and various skills and teamwork and communication abilities in neonatal transfer were compared before and after the implementation of the ADDIE instruction model.Results All of the 35 nurses had completed the training and responded to the survey.The scores in professional theoretical knowledge,practical skills and teamwork and communication abilities in the neonatal transfer nurses were all significantly increased after the training with ADDIE instruction model(P＜0.001).Conclusions On-the-job training of ADDIE instruction model among the neonatal transfer nurses can effectively enhance the professional knowledge and practice skills,enable the nurses to play a leading role in the process of treatment and improve abilities in teamwork and communication of the neonatal transfer nurses.The ADDIE instruction model provides valuable insights in the training of neonatal transfer nurses.

Objective To compare the effects of different crown materials on the stress distribution of dental implants by finite ele-ment method.Methods A three-dimensional finite element model of implant-supported crown restoration of the right mandibular first molar was established.Four kinds of crown restoration materials were used,including polymer infiltrated ceramic network Vita Enamic,resin nanoceramic Lava Ultimate,zirconia ceramic Cercon,and polyether-ether-ketone breCAM.A displacement load of 0.01 mm or 200 N was applied to the occlusal surface of the right mandibular first molar,and the analysis of reaction force,the maximum variability of shape,the maximum principal stress,the maximum equivalent stress was performed.Results The results of stress analysis under 0.01 mm displacement load showed that the maximum equivalent stress of Cercon was 937.30 MPa,and that of breCAM was 67.09 MPa.The stress concentration of crowns and implants was obvious.The maximum equivalent stress of the surrounding alveolar bone of Cercon was the highest(26.61 MPa),and that of breCAM was the lowest(3.87 MPa),which was about 1/7 of that of maximum group.The stress concentration range of resin-matrix ceramics and polyether-ether-ketone was relatively small,and the distribution was more uniform.When 200 N was applied,the maximum principal stress and the maximum equivalent stress distribution of the four models were similar,and the maximum variability of shape of breCAM was larger at the loading site.Conclusion Under the same displace-ment load,the stress concentration of polyether-ether-ketone and resin-matrix ceramics crown was lower than that of zirconia.There was no significant difference in stress concentration in the implant and surrounding alveolar bone among polyetheretherketone,resin-ceramic composite,and zirconia crown restorations under the same load.Further research on long-term durability of PEEK and resin-matrix ce-ramicsis needed through practical and clinical trials.

Objective:To understand the management status of breast cancer-related lymphedema, and to provide a basis for the formulation of prevention and treatment plans for breast cancer-related lymphedema.Methods:Using accidental sampling, a questionnaire designed by the research team was used to survey nurses in 58 hospitals in Jiangsu Province.Results:This study surveyed a total of 58 hospitals, of which 53 were general hospitals and 5 specialized hospitals. Only 11 hospitals (18.97%) had treatment rooms dedicated to conservative treatment of lymphedema, 9 hospitals (15.52%) had opened lymphedema clinics, and 15 hospitals (25.86%) had professional international lymphedema therapists. All the 58 hospitals had different degrees of prevention and management of breast cancer-related lymphedema.Conclusions:The comprehensive management of lymphedema has not yet been achieved, and the management standards of lymphedema also need to be further improved. It is important to establish a unified and standardized management plan and practice standards.

Objective To evaluate the prognostic value of a novel prediction model based on fibrinogen concentration in combination with neutrophil-to-lymphocyte ratio (F-NLR score) in patients with esophageal squamous cell carcinoma (ESCC) receiving neoadjuvant therapy and investigate their relationship with pathologic complete response (pCR).Methods Clinical data of 218 eligible ESCC patients treated with neoadjuvant therapy in the Affiliated Cancer Hospital of Zhengzhou University between 2012 and 2015 were retrospectively analyzed.The cut-off values for fibrinogen and neutrophil-to-lymphocyte ratio (NLR)were defined by the receiver operating characteristic (ROC) curve.The effects of different F-NLR scores on survival and pCR were evaluated.The survival rate was analyzed using the Kaplan-Meier method.The relationship among fibrinogen,NLR and pCR was analyzed by using Wilcoxon rank sum test.Results The 3-year overall survival (OS) rates with F-NLR scores of 0,1 and 2 were 72.1％,66.5％ and 50.2％(P=0.010),respectively.The corresponding 3-year disease-free survival (DFS) rates were 64.1％,60.2％ and 45.4％ (P=0.012),respectively.The clinical prognosis of patients with an F-NLR score of 2 was significantly worse compared with those of their counterparts with an F-NLR score of 0-1 (P=0.003).Multivariate analysis demonstrated that the F-NLR score (P=0.004) and TNM stage (P=0.000) were the independent prognostic factors.Conclusions The F-NLR score can be used as an independent prognostic factor for ESCC patients treated with neoadjuvant therapy,which is promising supplement to current TNM staging system,thereby facilitating more accurate risk stratification analysis and achieving individualized multidisciplinary treatment for ESCC patients.

Objective: To investigate the risk factors of suicide attempt and offer the prevention measures.Methods: This study collected the suicide attempters from 10 county hospitals through the hospital emergency and patient registration system in Shandong province from 2013-2015, and community control for the case was selected matched with community, gender, age (± 2 years). Questionnaire was used to collect data. The univariate statistical methods were adopted to preliminarily screen the influencing factors, and multivariate Logistic regression analysis was used to establish the model. Results: There were 424 cases including148 (34. 9％) males and 276 (65. 1％) females, 434 controls including 158 (36. 4％) males and 276 (63. 6％) females. Univariate and multivariate analysis both indicated that mental illness, poorer family economic status, poorer conjugal relationship, family history of attempted suicide, worse social relationships and poorer individual education opportunity were the risk factors of suicide attempt, but larger family member was the protective factor for the suicide attempts. Conclusion: Preventive measures should be taken to reduce suicide attempts.

OBJECTIVETo summarize the perioperative and postoperative complications follow laparoscopic intersphincteric resection (LapISR) in the treatment of low rectal cancer and their management.

METHODSAn observational study was conducted in 73 consecutive patients who underwent LapISR for low rectal cancer between June 2011 and February 2016 in our hospital. The clinicopathological parameters, perioperative and postoperative complications, and clinical outcomes were collected from a prospectively maintained database. Perioperative and postoperative complications were defined as any complication occurring within or more than 3 months after the primary operation, respectively.

RESULTSForty-nine(67.1%) cases were male and 24(32.9%) were female with a median age of 61(25 to 79) years. The median distance from distal tumor margin to anal verge was 4.0(1.0 to 5.5) cm. The median operative time was 195 (120 to 360) min, median intra operative blood loss was 100 (20 to 300) ml, median number of harvested lymph nodes was 14(3 to 31) per case. All the patients underwent preventive terminal ileum loop stoma. No conversion or hospital mortality was presented. The R0 resection rate was 98.6% with totally negative distal resection margin. A total of 34 complication episodes were recorded in 21(28.8%) patients during perioperative period, and among which 20.6%(7/34) was grade III(-IIII( according to Dindo system. Anastomosis-associated morbidity (16.4%,12/73) was the most common after LapISR, including mucosa ischemia in 9 cases(12.3%), stricture in 7 cases (9.6%, 4 cases secondary to mucosa necrosis receiving anal dilation), grade A fistula in 3 cases (4.1%) receiving conservative treatment and necrosis in 1 case (1.4%) receiving permanent stoma. After a median follow up of 21(3 to 60) months, postoperative complications were recorded in 12 patients (16.4%) with 16 episodes, including anastomotic stenosis (8.2%), rectum segmental stricture (5.5%), ileus (2.7%), partial anastomotic dehiscence (1.4%), anastomotic fistula (1.4%), rectovaginal fistula (1.4%) and mucosal prolapse (1.4%). These patients received corresponding treatments, such as endoscopic transanal resection, anal dilation, enema, purgative, permanent stoma, etc. according to the lesions. Six patients (8.2%) required re-operation intervention due to postoperative complications.

CONCLUSIONAnastomosis-associated morbidity is the most common after LapISR in the treatment of low rectal cancer in perioperative and postoperative periods, which must be strictly managed with suitable methods.

Adult ; Aged ; Anal Canal ; surgery ; Anastomosis, Surgical ; adverse effects ; Blood Loss, Surgical ; statistics & numerical data ; Colectomy ; adverse effects ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Surgical Procedures ; adverse effects ; Female ; Humans ; Ileostomy ; adverse effects ; Intestinal Mucosa ; pathology ; Ischemia ; etiology ; Laparoscopy ; adverse effects ; Lymph Node Excision ; statistics & numerical data ; Male ; Margins of Excision ; Middle Aged ; Necrosis ; etiology ; Operative Time ; Postoperative Complications ; etiology ; therapy ; Rectal Neoplasms ; complications ; surgery ; Rectovaginal Fistula ; etiology ; therapy ; Surgical Stomas ; Treatment Outcome

Objective To screen radiosensitizing-related genes mediated by elemene in lung adenocarcinoma A549 cells by using gene chip. Methods MTT test was used to calculate the IC50 of elemene. ①The effect of radiosensitivity was detected by colony forming assay. A549 cells were divided into 2 groups: radiation group and radiation + elemene group. Oligonucleotide chip was used to screen the gene expression changes of A549 cells from these 2 groups. The up-regulated gene Egr-1 and the down-regulated gene CyclinDl were selected to undergo RT-PCR so as to confirm the reliability of the result. Results MTT test showed the elemene inhibited the proliferation of the A549 cells dose-dependently. The IC50 value of elemene on the A549 cells was 120 mg/L. ②10 mg/L elemene had radiosensiting effect on A549 cells.The values of SERDO and SERDq obtained from the survival curve were (1.54±0. 20) and (1.43±0. 15 )respectively. Gene chip screened 122 differentially-expressed genes, including 89 up-regulated genes and33 down-regulated genes. ③These altered genes could be related to cell structure, substance metabolism,cell proliferation, cell differentiation, signal transduction, material transport, DNA repair, apoptosis,immune response and so forth. The RT-PCR results of Egr-1 and Cyclin D1 were consistent with the genenchip analysis.Conclusions The mechanism of elemene enhancing the radiosensitivity of lung adenoearcinoma A549 cells is the result of participation and collaboration of multiple genes. Further study of the newly-discovered differentially-expressed gene helps find out new radiosensitizational targets of elemene.

Objective To investigate the effect of elemene on the radiosensitivity of A549 cells and its possible molecular mechanism.Methods The effect of radiosensitivity was detected by colony forming assay.The protein expressions of DNA-PKcs,Bcl-2 and P53 were detected with Western blot.The correlation between the protein expression of DNA-PKcs and Bcl-2,DNA-PKcs and P53 was analyzed.Results Elemene had radiosensitizing effect on A549 cells,with the SERDo and SERDq 1.54 ± 0.20 and 1.43±0.15,respectively for 10 μg/ml elemene,and 1.63 ±0.32 and 1.75 ±0.19,respectively for 20 μg/ml elemene.Compared with irradiation group,the expression of DNA-PKcs was reduced significantly in 10,20 μg/ml elemene combined with radiation group ( t =7.52,8.33,P ＜ 0.05 ),so was for Bcl-2(t =10.74,11.33,P ＜0.05).The expression of P53 protein increased significantly (t =-9.25,7.66,P ＜0.05).There was a remarkable negative correlation between the expression of DNA-PKcs and P53(r =-0.569,P ＜0.05),and a remarkable positive correlation between DNA-PKcs and Bcl-2 (r =0.755,P ＜0.05 ).Conclusions Elemene has radiosensitizing effect on A549 cells,which might be related to down-regulation of DNA-PKcs gene expression,up-regulation of P53 and down-regulation of Bcl-2.