Malignant tumor metastasis is the key factor leading to poor prognosis of patients， and it is a difficult problem to be overcome in the field of tumor therapy. Metabolic reprogramming， as a key link in the regulation of tumor metastasis activity， affects the growth， invasion， and metastasis of tumor cells by changing the metabolic pathways of intracellular substances （such as glucose， amino acids， lipids， and nucleotides）. In particular， metabolic reprogramming plays a key role in the multistage linked steps related to tumor metastasis and can play a crucial role in several key stages of tumor tissue dissociation in situ， hematogenous metastasis， and remote colonization. Malignant tumor cells can selectively adjust their own metabolic state to adapt to the growth conditions of different metastatic microenvironments and colonization sites and then choose the most favorable growth and metabolism strategy. According to the holistic concept of traditional Chinese medicine （TCM）， the metastasis of malignant tumors is generally closely related to the metabolic state of the whole body. One of the advantages of TCM in the treatment of malignant tumors is systemic regulation. With its multi-pathway， multi-target， and multi-component therapeutic characteristics， TCM can effectively control the metastasis of malignant tumors by regulating the degradation of tumor epithelial mesenchymal transformation （EMT） and extracellular matrix （ECM）， anchoring the independent growth of tumor cells and the tumor microenvironment. In this paper， the potential regulatory effects of metabolic reprogramming on the metastasis of malignant tumors were discussed， and the latest research progress of the regulation of metabolic reprogramming by TCM on tumor metastasis was reviewed. At the same time， the key targets of TCM and its bioactive components in the process of tumor metastasis intervention were reviewed. This study aims to provide a more valuable basis and clearer idea for the treatment of malignant tumor metastasis by regulating metabolic reprogramming with TCM.

AIM: To analyze the effect of the new "dual track integration" training policy on graduate students of master's degree in hematology. METHODS: The graduate students of master's degree majoring in hematology from January, 2013, to September, 2018 at the First Affiliated Hospital of Wannan Medical College were retrospectively analyzed. They were divided into the "dual track integration" training group and "non-dual track integration" training group. Their health care ethics, basic knowledge in hematology, clinical skills, medical research capabilities, and employment were compared and analyzed. RESULTS: There were no significant differences with regard to the health care ethics, and employment by class A tertiary referral hospitals of the dual track group relative to those from the non-dual track group (P>0.05); However, the dual track training group scored much higher on their basic medical knowledge, clinical skills and reasoning than that of the non-dual track training group (P<0.05); The dual track training group published fewer papers than the non-dual track group (P<0.05). CONCLUSION: The dual track training system enhances significantly clinical skills and basic medical knowledge of graduate students of master's degree. However, more attention needs to be paid to improve their research capabilities.

OBJECTIVE：To study the effects of Modified liuwei dihuang decoction on kidney/bone injury of chronic kidney disease-mineral and bone disorder（CKD-MBD）model rats. METHODS ：The male SD rats were randomly divided into normal group（n＝10），high phosphorus group （n＝30），model group （n＝30），calcitriol group （positive control ，0.09 μg/kg，n＝30）， Modified liuwei dihuang decoction group （10 g/kg by crude drug ，n＝30）. CKD-MBD model was established by high phosphorus and adenine diet for 6 weeks. After modeling ，normal group and model group were given normal diet/high phosphorus diet and intragastric administration of water. Administration groups were fed with normal diet and given corresponding solution intragastrically（water as solvent ），0.1 mL/kg，once a day ，for consecutive 6 weeks. Blood sample of rats in the normal group were collected ，and they were sacrificed after the last administration. Blood sample of 10 rats in each other group were collected ， and they were sacrificed at 2，4 and 6 weeks after administration. The contents of blood urea nitrogen （BUN），serum creatinine （Scr），calcium，phosphorus，iPTH，FGF-23，RANKL and osteocalcin in serum were detected in each group. The bone mineral density（BMD）of femoral was measured ，the morphological changes of renal tissue and bone tissue were observed ，and the percentage of renal tubular injury and the score of renal interstitial fibrosis were calculated. RESULTS ：Compared with normal group，above indexes in high phosphorus group had no significant change at different time points （P＞0.05）. There was no abnormal change in renal/bone tissue. Compared with high phosphorus group at the same time point ，the contents of BUN ，Scr， phosphorus，iPTH，FGF-23，RANKL and osteocalcin in serum ，the percentage of renal tubular injury and the score of renal interstitial fibrosis in the model group were significantly increased ，while the contents of calcium in serum and the BMD of femoral were significantly decreased （P＜0.05 or P＜0.01）. The renal tissue showed diffuse fibrosis. The width of trabecular bone was increased and the number of osteoblasts was decreased. Compared with the model group at the same time point ，the contents of BUN（except for Modified liuwei dihuang decoction group after 2 weeks of administration ），Scr，serum phosphorus ，iPTH， FGF-23，RANKL and osteocalcin ，the percentage of renal tubular injury and the score of renal interstitial fibrosis in Modified liuwei dihuang decoction group and calcitriol group were decreased significantly at each time point ；serum calcium content and BMD（except for 2 weeks of administration ）were significantly increased （P＜0.05 or P＜0.01），and the pathological changes of renal/bone tissue were significantly improved ；there was no statistical significance in above indexes between Modified liuwei dihuang decoction group and calcitriol group （P＞0.05）. CONCLUSIONS ：Modified liuwei dihuang decoction can improve kidney/ bone injury of CKD-MBD model rats ，and improve BMD and regulate disorder of calcium and phosphorus metabolism.

Objective: To evaluate the success rate during ultrasound-guided percutaneous nephrolithotomy (PCNL) and analyze the reasons of puncture failure. Methods: A retrospective analysis was performed based on the data of 58 patients who underwent ultrasound-guided PCNL by 4 experienced urologists(10 years' experience of PCNL and more than 80 cases per year)in our center from August 2018 to November 2018. Of all the 58 patients, there were 36 males and 22 females (aged from 22 to 73 years) with the mean age of 51 years. The calculi ranged from 9 mm to 93 mm, with the average of 26.5 mm. The separation of renal collecting system ranged from 5 mm to 30 mm, with the average of 15.1 mm. All of the 58 patients underwent one-stage PCNL and the numbers of punctures, the numbers of percutaneous tubes and the reasons for failure were recorded. Results: All percutaneous tubes and surgeries were established and done successfully. Of all the 118 punctures, 74 punctures succeeded by detecting the urine and 68 surgery tracts were established (6 punctures failed because of the dilation). The total puncture success rate was 62.7%(74/118). Of the total 74 successful punctures, 56.8%(42/74)succeeded at the first puncture, 28.4%(21/74)succeeded at the second puncture and 14.9%(11/74)succeeded at least after three punctures. The success puncture rate of the 4 urologists were 59.2%(29/49), 64.1%(25/39), 66.7%(16/24), 66.7%(4/6)respectively, and there were no statistical differences between the puncture success rates of the urologists (P=0.679). Each channel needed 1.7 punctures on average. Fouty-four punctures failed without detecting the urine, including 20 failed punctures because of the puncture tract deviation, 17 punctures without seeing the urine after the core needle being removed, 7 punctures no display on the ultrasound imagine. There were 33 punctures to be tubeless while other 35 indwelling the nephrostomy tubes. Five nephrostomy tubes' position were different with the preoperationally predicted position which means the discrepancy rate was 14.3%(5/35). One patient had complications and classified as Grade II or above on the modified Clavien Grading System of aerothorax. Conclusions The puncture success rate during ultrasound-guided PCNL is not satisfied. The main reasons of puncture failure are the deviation of puncture tract, unclear imaging of puncture tract and other unclear reasons( puncture needle went too deep or superficially or tip of the needle embedded into the stone).

Objective To explore the monitoring of cerebrospinal fluid (CSF) dynamics in a model of brain herniation induced by acute intracranial hypertension in Guangxi Bama-Mini pigs by phasecontrast cine magnetic resonance imaging (PC cine MRI).Methods Femoral artery blood were extracted from 10 pigs,and injected into the frontal and temporal parietal lobe to make a model of brain herniation induced by acute intracranial hypertension.The mean arterial blood pressure (MAP),intracranial pressure (ICP),and cerebral perfusion pressure (CPP) were monitored.Routine T1WI,T2WI,coronal,sagittal and cerebrospinal fluid flow sequence (fast PC cine slice) which positioned on the cervical 3 (C3) vertebral body as the center and perpendicular to the spinal scans were performed on all experimental animals before and after blood injection with 3.0T Magnetic Resonance Imaging.The ICP,MAP,CPP,the absolute values of CSF peak flow velocity and the absolute value of carotid peak flow velocity before and after blood injection were compared.Results The ICP,MAP,CPP,and the absolute value of CSF peak flow velocity before injection of autologous arterial blood were statistically significant as compared with those after blood injection [(6.80±2.044) mmHg vs (52.20±1.619) mmHg,(76.80±7.068) mmHg vs (142.80±12.399) mmHg,(70.00±6.074) mmHg vs (90.50±12.250) mmHg,and the absolute value of CSF peak flow velocity was (243.20±77.671) mm/s vs (201.40±55.482) mm/s,respectively,P＜0.01].The absolute value of the peak velocity of the carotid artery before blood injection was not statistically significant compared with that after blood injection [(876.80±239.908) mm/s vs (799.40±241.829) mm/s,P＞0.05].Conclusion After the formation of brain herniation induced by acute intracranial hypertension,the CSF flow in the C3 level spinal canal showed a low dynamic change,and the CSF flow velocity waveform was disordered and malformed.The non-invasive measurement of CSF dynamics by PC cine MRI can provide an important basis for the change of CSF dynamics in the model of brain herniation induced by acute intracranial hypertension,and provide a theoretical basis for further research on damage control neurosurgery in the future.

BACKGROUND/AIMS: Neurotensin is a gut-brain peptide with both inhibitory and excitatory actions on the colonic musculature; our objective was to understand the implications of this for motor patterns occurring in the intact colon of the rat. METHODS: The effects of neurotensin with concentrations ranging from 0.1-100 nM were studied in the intact rat colon in vitro, by investigating spatio-temporal maps created from video recordings of colonic motility before and after neurotensin. RESULTS: Low concentration of neurotensin (0.1-1 nM) inhibited propagating long distance contractions and rhythmic propagating motor complexes; in its place a slow propagating rhythmic segmental motor pattern developed. The neurotensin receptor 1 antagonist SR-48692 prevented the development of the segmental motor pattern. Higher concentrations of neurotensin (10 nM and 100 nM) were capable of restoring long distance contraction activity and inhibiting the segmental activity. The slow propagating segmental contraction showed a rhythmic contraction—relaxation cycle at the slow wave frequency originating from the interstitial cells of Cajal associated with the myenteric plexus pacemaker. High concentrations given without prior additions of low concentrations did not evoke the segmental motor pattern. These actions occurred when neurotensin was given in the bath solution or intraluminally. The segmental motor pattern evoked by neurotensin was inhibited by the neural conduction blocker lidocaine. CONCLUSIONS: Neurotensin (0.1-1 nM) inhibits the dominant propulsive motor patterns of the colon and a distinct motor pattern of rhythmic slow propagating segmental contractions develops. This motor pattern has the hallmarks of haustral boundary contractions.
Absorption ; Animals ; Baths ; Colon* ; In Vitro Techniques ; Interstitial Cells of Cajal ; Lidocaine ; Myenteric Plexus ; Neural Conduction ; Neurotensin* ; Peristalsis ; Rats* ; Receptors, Neurotensin ; Video Recording

Objective To investigate the change of regulatory T-cells (Treg) before and after therapy in patients with autoimmune hemolytic anemia (AIHA),and to study the role of Treg in AIHA.Methods Treg cells numbers was measured by flow cytometry.Results Before treatment,Treg cells in AIHA patients was (1.32 ± 0.87) ％,which was significantly lower than (3.08 ± 0.96) ％ in the controls (t =-5.37,P ＜ 0.01).After treatment,Treg cells in AIHA patients was significantly increased [(4.96 ± 1.13)％] (t =-16.94,P ＜0.01).Conclusion Treg cells decreased in AIHA patients.Glucocorticoid might play a role in AIHA treatment by up-regulating Treg cells number.

Objective To explore the correlation between cholecystectomy and colorectal adenoma.Methods A total of 981 patients who underwent colonoscopy between January 2007 to December 2012 at Wuhan Central Hospital were enrolled in the study according to the inclusion criteria.The patients were divided into cholecystectomy group (n=216) and control group(n=765) in terms of cholecystectomy or not.The incidence of colorectal adenoma ,gender ,age ,location and pathological type of ade-noma were analyzed in the two groups.Results Significant differences were noted in the incidence and location of colorectal ad-enoma ,and gender between the two groups (P< 0.05).The incidence of colorectal adenoma was higher in cholecystectomy group than in control group ;the number of female patients with colorectal adenoma was greater than that of male patients ;the incidence of proximal colorectal adenoma was higher than that of distal adenoma.But the average age of patients with adenoma was not significantly associated with the pathological types of adenoma in both groups (P>0.05).Conclusion Cholecystecto-my is closely associated with the occurrence of colorectal adenoma.Screening for colorectal adenoma should be considered in the patients with gall bladder removal.

Objective To explore the effect and mechanism of somatostatin and proton pump inhibitor (PPI) on Iks in pancreatic acini (RPA) by testing the change of slowly-activiting voltagedependent K+ channel current (Iks).Methods Pancreatic acini was isolated and its suspension was obtained.Iks values of different groups were recorded by an EPC10 patch clamp amplifier and the difference among the groups was compared.The groups were divided as followed:washing solution treated as control group,5 μmol/L or 20 μmol/L 293B groups,5 nmol/L secretin group,5 nmol/L secretin with somatostatin at 100 nmol/L or 10 nmol/L or 1 nmol/L groups,0.3 nmol/L 8Br-cAMP group,0.3 nmol/L 8Br-cAMP with 100 nmol/L somatostatin group,1 μmol/L acetylcholine group,1μmol/L acetylcholine with 100 nmol/L somatostatin group,5 nmol/L secretin with omeprazole at 10-5 mol/L or 10-6 mol/L or 10-7 mol/L groups,1 μmol/L acetylcholine with omeprazole at 10-5 mol/L or 10-6mol/L or 10-7 mol/L groups.Groups were compared by ANOVA,P ＜ 0.05 was considered statistically significant.Results The resting membrane voltage of rat RPA was - (40 ± 0.8) mV,and when depolarization to +10 mV,Iks of control group was (420.0±3.2) pA.After treated with 5 μmol/L or 20 μmol/L 293B,Iks of RPA decreased to (60.4±4.2)％ and (30.2±3.1)％(F=6.87,P＜0.05) of control group.Stimulated with 5 nmol/L secretin,Iks increased to (823.0±2.2) pA,and after adding somatostatin at 100 nmol/L or 10 nmol/L or 1 nmol/L,Iks decreased to (510.0±3.2) pA,(584.0±2.8) pA and (789.0±6.9) pA respectively(F=5.67,P＜0.05),after adding omeprazole at 10-5mol/L or 10-6mol/L or 107mol/L,the peak of Iks was (806.5±3.6) pA,(814.8±3.2) pA and (816.3±2.9) pA (P＞0.05).After stimulated with 1 μmol/L acetylcholine,the peak value of Iks was (966.0± 3.2) pA,and after adding omeprazole at 10-5 mol/L or 10-6 mol/L or 107mol/L,the peak of Iks was (956.3±10.3) pA,(957.5±8.6) pA and (960.0±8.4) pA (P＞0.05).Conclusion Somatostatin can inhibit Iks opening,and there is no significant inhibition of PPI on this channel.

Alzheimers disease is the most common cause of progressive decline of mental function. Recent years there is a large development in the early diagnosis and therapeutic progress in Alzheimer disease. The article reviews the progress in the pathogenesis, early diagnosis and new therapies in Alzheimers disease.