Objective To investigate the effects of permissive hypercapnia(PHC)combined with remote ischemic preconditioning(RIPC)on regional brain oxygen saturation(rSO2)and postoperative cognitive function in patients undergoing thoracoscopic radical resection for lung cancer.Methods A total of 80 patients who underwent thoracoscopic lung cancer resection in Jinhua Municipal Central Hospital from January to December 2022 were selected and divided into control group,RIPC group,PHC group and PHC+RIPC group according to random number table method,with 20 cases in each group.rSO2 levels were observed before anesthesia induction(T0),before unilateral ventilation(T1),10min after unilateral ventilation(T2),30min after unilateral ventilation(T3),at the end of after unilateral ventilation(T4)and after surgery(T5)in four groups.The level of serum interleukin(IL)-6,IL-10,tumor necrosis factor-α(TNF-α)and cognitive function at T0,T4,the first day after surgery(T6)and the third day postoperative(T7)were recorded.Results After surgery,the levels of IL-6,TNF-α,and IL-10 in four groups first increased and then decreased(P＜0.05).At T4 and T6,there were statistically significant differences in IL-6 levels among four groups(P＜0.05),and the IL-6 level of control group was significantly higher than that of other three groups(P＜0.05).At T4,T6 and T7,there were statistically significant differences in IL-10 and TNF-α levels among four groups(P＜0.05),and the IL-10 level in control group was significantly lower than that in other three groups,and the TNF-α level was significantly higher than that in other three groups.At T2,T3,T4 and T5,there were statistically significant differences in rSO2 between four groups(P＜0.05),and PHC+RIPC group＞RIPC group＞PHC group＞control group.At T6,the score of mini-mental state examination scale of control group was significantly lower than that of other three groups(P＜0.05).Conclusion PHC combined with RIPC can improve rSO2 and postoperative cognitive function in patients with thoracoscopic lung cancer resection,reduce the level of inflammatory factors,and reduce the occurrence of postoperative cognitive dysfunction.

Objective To investigate the effects of permissive hypercapnia(PHC)combined with remote ischemic preconditioning(RIPC)on regional brain oxygen saturation(rSO2)and postoperative cognitive function in patients undergoing thoracoscopic radical resection for lung cancer.Methods A total of 80 patients who underwent thoracoscopic lung cancer resection in Jinhua Municipal Central Hospital from January to December 2022 were selected and divided into control group,RIPC group,PHC group and PHC+RIPC group according to random number table method,with 20 cases in each group.rSO2 levels were observed before anesthesia induction(T0),before unilateral ventilation(T1),10min after unilateral ventilation(T2),30min after unilateral ventilation(T3),at the end of after unilateral ventilation(T4)and after surgery(T5)in four groups.The level of serum interleukin(IL)-6,IL-10,tumor necrosis factor-α(TNF-α)and cognitive function at T0,T4,the first day after surgery(T6)and the third day postoperative(T7)were recorded.Results After surgery,the levels of IL-6,TNF-α,and IL-10 in four groups first increased and then decreased(P＜0.05).At T4 and T6,there were statistically significant differences in IL-6 levels among four groups(P＜0.05),and the IL-6 level of control group was significantly higher than that of other three groups(P＜0.05).At T4,T6 and T7,there were statistically significant differences in IL-10 and TNF-α levels among four groups(P＜0.05),and the IL-10 level in control group was significantly lower than that in other three groups,and the TNF-α level was significantly higher than that in other three groups.At T2,T3,T4 and T5,there were statistically significant differences in rSO2 between four groups(P＜0.05),and PHC+RIPC group＞RIPC group＞PHC group＞control group.At T6,the score of mini-mental state examination scale of control group was significantly lower than that of other three groups(P＜0.05).Conclusion PHC combined with RIPC can improve rSO2 and postoperative cognitive function in patients with thoracoscopic lung cancer resection,reduce the level of inflammatory factors,and reduce the occurrence of postoperative cognitive dysfunction.

Immune checkpoints include a series of receptor-ligand pairs that play a key role in the proliferation, activation, and immune regulatory responses of immune cells. Although immune checkpoint inhibitors (ICIs), such as programmed death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) have achieved good therapeutic effects in clinical practice, some patients still experience ineffective treatment and immune resistance. A large amount of evidence has shown that immune checkpoint proteins are related to cell metabolism during immune regulation. On the one hand, immune checkpoints connect to alter the metabolic reprogramming of tumor cells to compete for nutrients required by immune cells. On the other hand, immune checkpoints regulate the metabolic pathways of immune cells, such as phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) to affect the activation of immune cells. Based on a review of the literature, this article reviews the mechanisms by which PD-1, CTLA-4, T cell immunoreceptor with Ig and ITIM domains (TIGIT), T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3), cluster of differentiation 47 (CD47), and indoleamine 2,3-dioxygenase 1 (IDO1) regulate cell metabolic reprogramming, and looks forward to whether targeting the ligand-receptor pairs of immune checkpoints in a "dual regulation" manner and inhibiting metabolic pathways can effectively solve the problem of tumor immune resistance.
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Humans ; Neoplasms/genetics* ; Metabolic Networks and Pathways/immunology* ; Animals ; Immune Checkpoint Inhibitors/pharmacology*

Existing traditional Chinese medicine (TCM)-related databases are still insufficient in data standardization, integrity and precision, and need to be updated urgently. Herein, an Encyclopedia of Traditional Chinese Medicine version 2.0 (ETCM v2.0, http://www.tcmip.cn/ETCM2/front/#/) was constructed as the latest curated database hosting 48,442 TCM formulas recorded by ancient Chinese medical books, 9872 Chinese patent drugs, 2079 Chinese medicinal materials and 38,298 ingredients. To facilitate the mechanistic research and new drug discovery, we improved the target identification method based on a two-dimensional ligand similarity search module, which provides the confirmed and/or potential targets of each ingredient, as well as their binding activities. Importantly, five TCM formulas/Chinese patent drugs/herbs/ingredients with the highest Jaccard similarity scores to the submitted drugs are offered in ETCM v2.0, which may be of significance to identify prescriptions/herbs/ingredients with similar clinical efficacy, to summarize the rules of prescription use, and to find alternative drugs for endangered Chinese medicinal materials. Moreover, ETCM v2.0 provides an enhanced JavaScript-based network visualization tool for creating, modifying and exploring multi-scale biological networks. ETCM v2.0 may be a major data warehouse for the quality marker identification of TCMs, the TCM-derived drug discovery and repurposing, and the pharmacological mechanism investigation of TCMs against various human diseases.

Objective:To evaluate biological dose and retrospective biodosimetry of a case of large area back skin injury caused by suspected interventional procedure.Methods:Peripheral blood from the patient was collected at about 7 months after interventional procedure, and the chromosomal aberrations in peripheral blood cells were analyzed to evaluate the retrospective biodosimetry using the correction factor of dose estimation, Dolphin′s model and Qdr method, respectively. Results:Based on the amounts of semi-automated dic and manually detected dic plus ring, the whole-body average absorbed dose of the victim was estimated to be 0.68-0.95 Gy by four different dose response curves. Over dispersion of dic or dic plus ring was also detected, and the efficiency of dose assessment was obviously increased using dic semi-automatic detection. Based on three different retrospective biodosimetry models, the estimated average absorbed dose was further corrected to be between 1.80-2.86 Gy, which was consistent with clinical diagnosis of degree Ⅳ radiation skin injury.Conclusions:A case of suspected radiation skin injury was confirmed by chromosomal aberration analysis and it’s biodosimetry was reconstructed, suggesting that the unstable chromosomal aberration analysis may be applicable to assess the retrospective biodosimetry of non-uniform local radiation exposure.

Objective To compare the tumor characteristics and survival between postoperative incidentally discovered gallbladder cancer (ID-GBC) and preoperatively suspected gallbladder cancer (PS-GBC).Methods The data of 276 GBC patients who underwent surgical resection with curative intent between January 2004 and December 2014 at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed.Results The 1-,3-,and 5-year cumulative survival rates of the ID-GBC group (88.8％,52.2％,and 33.0％,respectively) were significantly better than those in the PS-GBC group (57.5％,25.7％,and 16.6％,P ＜ 0.05).In the ID-GBC group,multivariate analysis revealed that T staging,hepatic invasion and time interval from cholecystectomy to re-operation were independent prognostic factors.The overall survival (OS) in the group with the time interval within 2 weeks was significantly better than those in the other two groups (both P ＜ 0.05).However,there were no significant differences in OS between the groups with the time interval of 2 weeks to 1 month and more than 1 month (P ＞ 0.05).Conclusions Postoperative ID-GBC had significantly better survival outcomes than PS-GBC.Reoperation within two weeks in patients with ID-GBC is a good strategy.

Natural lignocellulosic materials contain cellulose, hemicellulose, and lignin. Cellulose hydrolysis to glucose requires a series of lignocellulases. Recently, the research on the synergistic effect of lignocellulases has become a new research focus. Here, four lignocellulase genes encoding β-glucosidase, endo-1,4-β-glucanase, xylanase and laccase from termite and their endosymbionts were cloned into pETDuet-1 and pRSFDuet-1 and expressed in Escherichia coli. After SDS-PAGE analysis, the corresponding protein bands consistent with the theoretical values were observed and all the proteins showed enzyme activities. We used phosphoric acid swollen cellulose (PASC) as substrate to measure the synergistic effect of crude extracts of co-expressing enzymes and the mixture of single enzyme. The co-expressed enzymes increased the degradation efficiency of PASC by 44% compared with the single enzyme mixture; while the degradation rate increased by 34% and 20%, respectively when using filter paper and corn cob pretreated with phosphoric acid as substrates. The degradation efficiency of the co-expressed enzymes was higher than the total efficiency of the single enzyme mixture.
Animals ; Cellulase ; Cellulose ; Hydrolysis ; Isoptera ; Lignin ; Symbiosis ; beta-Glucosidase

Objective: To explore the treatment technique, occurrence and development patterns of such radiation injuries as in a major radiological accident in which a victim suffered mild bone marrow radiation sickness combined grade degree Ⅲ acute radiation induced skin injury, based on his dose estimation, clinical manifestations and disease treatments. Methods: History inquiry in detail, earlier physical dose estimation and biological dose estimation were conducted in conjunction with analyzing the chromosome aberration of peripheral blood lymphocytes. The physical dose was estimated by Monte Carlo method.The systematic laboratory and imaging examination was performed to evaluate the condition. The comprehensive analysis was conducted to determine the diagnosis and treatment plan. Results: At 3d after the exposure, "Ren" felt mild pain and discomfortable on the skin of the right index finger. The body of the right hand index finger was covered with blister at 21 d after exposure.The estimation of biological dose was 0.43 Gy (95%CI: 0.31-0.58 Gy), and the physical dose was estimated to be 36-164 Gy for each part of the right hand finger. The hematopoietic system, immune system and endocrine system were normal. The liver function index value was transiently increased. The liver damage resulted from the use of antibiotic-induced combined with the patient′s past medical history and admission examination result, and the relevant antibiotics were discontinued. The liver function returned to normal after liver protection treatment. At 22 d after irradiation, a right finger incision and decompression surgery were performed. The stem cells were extracted and implanted into the right index finger. After 59 days of hospitalization, there was no obvious discomfort in the body, and the right index finger recovered well, as well as the pain significantly relieved, and the knuckle activity was basically normal. Conclusions The patient with excessive radiation and grade Ⅲ acute radiation skin injury was successfully treated, and local application of autologous adipose-derived stem cell transplantation achieved good result .

Objective To compare the Modified Early Warning Score(MEWS),blood glucose value score and the two scores combined with the ability to predict the prognosis of patients with acute complication of diabetes mellitus,and to explore the most suitable assessment tools. Methods 419 patients with acute complica-tions were collected in diabetic mellitus. To put the admission time as the inital observation point,MEWS score, blood glucose value score and MEWS combined with blood glucose value were assessed and compared between the time point of admission and discharge by ROC curve.Results Using death as a prediction index,MEWS score of subjects operating characteristic area under the curve of AUCROC was 0.875 and the optimal cut-off value of was over 4 in the sensitivity of 78.43%,specificity of 85.60%,the positive predictive valueof 43.01% and the negative predictive value of 96.63% independently. The average score of blood glucose area under ROC curve AUCROC was 0.681 and the optimal cut-off value was 2 in the sensitivity of 50.98%,the specificity of 85.33% the positive predictive value of 73.4% and negative predictive value of 67.5% respectively. Two scores combined with area under ROC curve AUCROCwas 0.982,and the optimal cut-off value was over 7 in the sensitivity of 94.12%,the specificity of 95.65%,the positive predictive value of 75% and the negative predictive value of 99.15% individually. Conclusion For predicting the prognosis of patients with acute complications of diabetes,the combined scores are better than the pure MEWS score and blood glucose value.It is worth of clinical application.

Objective To observe the impact of laparoscopic Roux-en-Y gastric bypass on bowel habits in patients with type 2 diabetes mellitus(T2DM).Methods 70 cases of T2DM undergoing laparoscopic Roux-en-Y gastric bypass were studied.Changes in bowel habits, frequency and odor of flatulence, and social life were estimated at least 6 months after surgery using a self-administered questionnaire.Results 67.1%of the patients had normal bowel habit, 68.6%of patients maintained normal flatus before undergoing surgery, and visual ana-logue scale reveals bowel and flatus habit would cause little trouble on daily life.47.1% of patients maintained their normal bowel habit, and 45.7%of patients had loose stools and diarrhea after surgery.The number of pa-tients with loose stools significantly increased(28/70, 40% after surgery vs 5/70, 7.1% before surgery), with statistical difference( P<0.001) .42.9%patients believed that eating high-fat diet was related with loose stools (P<0.001).Patients with constipation decreased significantly after surgery(5/70, 7.1% vs the preoperative 16/70, 22.9%), with statistical difference(P=0.016).Visual analogue scale showed that 57.1% of patients thought their daily life and social activities were not affected(P=0.05).50%of patients considered an increase flatus, and 55.7%had malodorous flatus, which had statistical significance compared with those before surgery ( P<0.001) .A visual analogue scale showed that 60%of patients thought that this change would not affect their daily life and social activities( P=0.212) .Conclusions After laparoscopic Roux-en-Y gastric bypass surgery, some patients had loose stod, diarrhea, increased flatus and and offensive odor, but after proper treatment these changes do not affect their daily life and social activities.