Objective:To investigate the efficacy of Tanzhuo Decoction in the treatment of early diabetic nephropathy in patients with type 2 diabetes mellitus and its effect on cystatin C (Cys-C), C-reactive protein (CRP), urinary albumin excretion rate (UAER), and creatinine clearance rate (CCr). Methods:Eighty patients with type 2 diabetes mellitus complicated by early diabetic nephropathy who received treatment at Maanshan Hospital of Traditional Chinese Medicine from 2019 to 2021 were included in this randomized controlled study. They were divided into a control group ( n = 40) and a treatment group ( n = 40) using the random number table method. Patients in the control group received conventional therapy including blood glucose and blood pressure control, while those in the treatment group received Tangzhuo Decoction in addition to the same treatment as that given to the control group. Both groups of patients were treated for 30 days. The clinical efficacy as well as pre- and post-treatment Cys-C, CRP, UAER, and CCr were compared between the two groups. Results:The total response rate in the treatment group was 92.5% (37/40), which was significantly higher than 75.0% (30/40) in the control group ( χ2 = 4.50, P < 0.05). After treatment, Cys-C, CRP, and UAER in the treatment group were (2.04 ± 0.08) mg/L, (3.97 ± 1.71) mg/L, and (91.18 ± 18.68) μg/min, respectively, which were significantly decreased compared with those before treatment ( t = 12.14, 5.59, 4.73, all P < 0.05). After treatment, CCr in the treatment group was (56.3 ± 5.01) mL/min, which was significantly increased compared with that before treatment ( t = -8.56, P < 0.05). After treatment, Cys-C, CRP, and UAER in the control group were (2.17 ± 0.04) mg/L, (4.66 ± 1.47) mg/L, and (103.93 ± 22.62) μg/min, respectively, which were significantly decreased compared with those before treatment ( t = 4.05, 5.00, 2.24, all P < 0.05). After treatment, CCr in the control group was (45.9 ± 4.9) mL/min, which was significantly increased compared with that before treatment ( t = -3.98, P < 0.05). There were significant differences in Cys-C, UAER, and CCr between the treatment and control groups ( t = -7.42, -2.29, 7.82, all P < 0.05). Conclusion:Tanzhuo Decoction for the treatment of early diabetic nephropathy in patients with type 2 diabetes mellitus has a definite effect. It can effectively reduce levels of Cys-C and UAER, reduce inflammatory reactions, improve kidney function, and delay the progression of kidney injury.

Immune checkpoint inhibitors (ICIs), including programmed death receptor-1 (PD-1)/ligand (PD-L1) and cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) monoclonal antibody, have been approved for the treatment of multiple advanced malignant tumors, on account of its ideal antitumor activity. For patients receiving ICIs treatment, glucocorticoid intervention and treatment are often applied because of some complications associated with tumor, immunotherapy-related adverse reactions, and pretreatment before immunotherapy combined with chemotherapy. However, excessive physiological dose of glucocorticoid has a certain immunosuppressive effect, which may even affect the curative efficacy of ICIs. Thus, there are controversies about the use of steroids in patients receiving ICIs treatment. In this article, we reviewed the progress of steroids effect on the efficacy of ICIs.

Objective: To assess value of contrast enhanced ultrasound (CEUS) in TN staging of pancreatic cancer and compared with contrast enhanced computed tomography(CECT). Methods: Seventy-eight cases with pancreatic cancer confirmed by pathology were enrolled in this study. All patients were examined using CEUS and CECT and staged according to the 8th guideline of pancreas tumors of AJCC. The diagnostic accuracies of CEUS in TN staging of pancreas tumors were compared with CECT. Results: The diagnostic accuracies of CEUS in T staging and N staging of pancreatic cancer were 80.8%, and 78.2%, respectively. For CECT, the diagnostic accuracies in T staging and N staging were 88.5%, and 88.5%, respectively. There was no significant difference in the diagnostic accuracies between CEUS and CECT in T staging(χ²=1.56, P=0.21). The diagnostic accuracy of CEUS in N staging was significantly lower than that of CECT(χ²=3.86, P=0.04). Conclusions The diagnostic accuracy of CEUS in T staging of pancreatic cancer is similar to that of CECT, while in its N staging is lower than that of CECT.

Objective To establish an intestinal organoid-based assay to investigate the radiation mitigation effect of epiregulin in vitro. Methods Intestinal crypts were released from tissue incubated with EDTA. Intestinal crypts seeded in 3D matrigel were irradiated at 24 h after plating. The radiation mitigation effect of epiregulin was evaluated by measuring the survival rate, size and budding numbers of the organoid after irradiation, and the basic FGF was used as a positive control of epiregulin. Results Radiation-induced lethality and dose-dependent survival curve of the intestinal organoid were consistent with in vivo data. Treatment with epiregulin (400 ng/ml) at 24 h post-radiation significantly increased survival rate of 8 Gy X-ray irradiated intestinal organoid in comparison with non-treated group [(12.56 ± 1.02)％vs. (4.73 ± 0.38)％, t=12.43,P<0.05]. Conclusions Epiregulin has radiation mitigation effect on intestinal organoid and could serve as a potential medical countermeasure to mitigate gastrointestinal toxicity.

Objective To discuss the safety and the application of the self-designed multifunctional inflatable pelvis and hip-joint fixator (MIPHF) in damage control in pelvic fracture patients.Methods The MIPHF was subjected to pressure test and quality inspection.From September 2016 to June 2017,61 pelvic-fracture patients were treated with our self-designed MIPHF as pre-hospital first-aid care according to the concept of damage control orthopedics (DCO) (MIPHF group).The control group consisted of 69 pelvic-fracture patients who had not received pre-hospital first-aid care with the self-designed MIPHF from December 2015 to August 2016.There were no statistically significant differences between the two groups in gender,age,types of pelvic fracture,and preoperative injure severity score (ISS).The study compared the two groups for the case fatality rate,volume of blood transfused during surgeries,early complication rates,fracture reduction (Matta standards),and long-term efficacy (Cole scores).Results The pressure test showed that the MIPHF had a good fixation effect on the pelvis.And the quality inspection showed that the material used for the MIPHF was in line with national standards and the safety was guaranteed.The MIPHF group had 1 death (1.6％) and the control group had 8 deaths (11.6％),which was a significant difference (x2=4.979,P=0.026).All survival patients in both groups were followed up.The MIPHF group (61 cases) received 3.0 to 18.0 months follow-up,with an average of 9.0 months.And the control group (69 cases) had 18.0 to 30.0 months follow-up,with an average of 21.9 months.In the MIPHF group,23 cases were treated conservatively,and 37 cases were treated with surgery.Among them,3 cases were fixed with external fixator,20 cases with anterior open reduction and internal fixation,9 cases with posterior open reduction and internal fixation,and 5 cases with combined anterior and posterior fixation.The timing of surgery was 1 to 20 days after injury,with an average of 4.1 days.The volume of blood transfused in the MIPHF group during surgery was 200 to 1500 ml,with an average of 628.6 ml.In the control group,27 patients were treated conservatively,and 42 patients were treated with surgery.Among them,2 cases were fixed with external fixator,24 cases with anterior open reduction and internal fixation,10 cases with posterior open reduction and internal fixation,and 6 cases with combined anterior and posterior fixation.The timing of surgery was 1 to 15 days after injury,with an average of 3.l days.The volume of blood transfused in the control group during surgery was 200 to 4000 ml,with an average of 1 707.1 ml.There was a significant difference between the two groups in intraoperative blood transfusion(Z=-2.330,P=0.020).The MIPHF group had 10 (16.4％) cases of early serious complications and the control group had 22 (31.9％) cases,which had a significant difference (x2=4.187,P=0.041).According to the criteria proposed by Matta et al.,the good rate of results for treating fractures was 82.0％ in the MIPHF group and 60.9％ in the control group,which got a significant difference (x2=6.967,P=0.008).The MIPHF group and the control group also differed significantly in their mean long-term Cole scores (27.2±4.0 versus 25.1 ±5.6,t=2.457,P=0.015).Conclusion MIPHF,which reflects the DCO concept,may be recommended as pre-hospital first-aid care for patients with pelvic fracture because it can lessen bleeding and prevent secondary pelvic injury,thus reduce case fatality rate and the incidence of complications.It can also improve the success rate of treating pelvic fracture,which will positively affect long-term outcomes.

Objectives To systematically evaluate the effect of music given to pregnant rats on the development of brain functions in the offspring rats and to provide scientific evidence for the application of antenatal musical training and the promotion of welfare for laboratory animals.Methods We comprehensively retrieved and collected the research literatures related to the effect of music on brain function development in offsprings of the pregnant rats from Pubmed,Web of Science,Cochrane Library,Wanfang,Weipu,CNKI and CBMdisc.The retrieval time was set from the foundation date of databases to 2 April,2016.We selected literatures according to the inclusion and exclusion criteria,evaluated their utilities,then extracted and qualitatively described the data.Results Seven experimental studies were selected in this study including 4 published in Chinese and 3 in English.The object laboratory animals of those studies were Wistar or SD rats.Music materials involved comfort music,classic music,violin concerto(Liangzhu/The butterfly lovers).Intervention were given to the pregnant rats roundly from the gestation until parturition.These results showed that,to some extent,music stimulations during gestation may promote the development of brain function and improve spatial memory of the offspring rats.However,expressions of some functional receptors were not significantly altered.Conclusions Appropriate music provided to the pregnant rats promote the development of brain functions in their offspring.

Objective: To investigate the relationship between PD-L1 expression and the clinicopathologic features and prognosis in triple-negative breast carcinomas (TNBC). Methods: All 142 cases of TNBC were collected from the First Affiliated Hospital of Nanjing Medical University from February 2011 to December 2014, and the surgical excision or biopsy specimens from patients without chemotherapy and radiotherapy were included. Histopathologic analysis of stromal tumor infiltrating lymphocyte (sTIL) was performed on HE sections, and PD-L1 immunohistochemical staining was done with MaxVision. Results: The PD-L1 expression rate was 34.5% (49/142) in tumor cells, and was 62.0% (88/142) in sTIL. The PD-L1 expression in tumor cells was positively correlated with tumor size (r=0.181, P=0.031), Ki-67 index (r=0.211, P=0.012), sTIL (r=0.380, P<0.01) and PD-L1 expression in sTIL (r=0.447, P<0.01). The PD-L1 expression in sTIL was positively correlated with tumor grade (r=0.215, P=0.01), Ki-67 index (r=0.253, P=0.002) and sTIL (r=0.370, P<0.01). The high stromal CD8⁺ /FOXP3⁺ ratio was significantly associated with improved overall survival (χ²=4.186, P=0.041). The high percentage of sTIL was significantly associated with improved overall survival (χ²=12.427, P<0.01) and progression-free survival (χ²=4.057, P=0.044). Conclusions In TNBC, PD-L1 expression is positively correlated with Ki-67 and sTIL; the stromal CD8⁺ /FOXP3⁺ ratio and sTIL are significantly associated with prognosis. The PD-L1 expression, stromal CD8⁺ /FOXP3⁺ ratio and sTIL are biologically important in TNBC, and all these correlative factors are important potential parameters in assessing immunotherapy for TNBC.

Objective:To study the changes and significance of Th17 and Treg cells as well as their associated cytokines in pe-ripheral blood of patients with chronic hepatitis C and cirrhosis in order to investigate their role in the pathogenesis of chronic hepatitis C and hepatitis C cirrhosis. Methods:Flow cytometry and ELSIA assay were used to detect the expression ratio of Th17 and Treg cells and the serum levels of IL-10,TGF-β,IL-6 and IL-17 in peripheral blood of healthy human and patients with chronic hepatitis C and hepatitis C cirrhosis. Than we analyzed the differences of the above detection index between the healthy and patients with chronic hepatitis C and hepatitis C cirrhosis. Results:The expression ratio of Th17 cells (1. 33%±0. 30%) in peripheral blood of patients with chronic hepatitis C and IL-6[(8. 10±2. 42)ng/L] and IL-17[(16. 70±4. 73)ng/L] serum levels were significantly higher than those in the healthy (Th17:1. 14%±0. 19%) and IL-6[(1. 72±6. 70)ng/L],IL-17[(12. 29±1. 88)ng/L],P<0. 05;The expression ratio of Treg cells in peripheral blood of patients with hepatitis C cirrhosis and chronic hepatitis C patients was significantly higher than that in the healthy (6. 21%±0. 76%,5. 89%±0. 85% vs 5. 51%±0. 59% ),P<0. 05,The ratio of Th17/Treg in patients with cirrhosis was significantly lower than that in patients with chronic hepatitis C and the healthy(0. 19±0. 02 vs 0. 22±0. 03,0. 21±0. 03),P<0. 05;the levels of IL-1[(16. 21±3. 76)ng/L] and TGF-β[(5. 15±0. 83)ng/L] in peripheral blood of patients with hepatitis C cirrhosis were significantly higher than those in chronic hepatitis C[(14. 36±2. 78)ng/L;(4. 47±0. 87)ng/L] and the healthy[(14. 01±3. 01)ng/L;(4. 43±0. 98)ng/L)],P<0. 05. Conclusion:Th17 and Treg cells and their related cytokines involved in the process of chronicity of hepatitis C and cirrhosis,Th17 and Treg cells and their related cytokines in the treatment and prevention of chronicity of hepatitis C and cirrhosis may have important significance.

OBJECTIVE:To investigate the effects of Jintiange capsules combined with zoledronic acid on bone mineral densi-ty(BMD),VAS scores and lab indexes of patients with postmenopausal diabetic osteoporosis. METHODS:140 patients with post-menopausal diabetic osteoporosis were divided into control group and treatment group according to randomized blocks,with 70 cas-es in each group. Both group received 0.9% Sodium chloride injection 100 ml intravenously before and after treatment,and were given vitamin D and calcium. Control group was given Zoledronic acid injection 5 mg intravenously for more than 15 min,once ev-ery 4 weeks. Treatment group was additionally given Jintiange capsules 1.2 g,po,tid,on the basis of control group. Both groups received 6 months of treatment. BMD,VAS score,lab indexes before and after treatment and the occurrence of ADR were com-pared between 2 groups. RESULTS:After treatment,BMD of 2 groups were increased significantly compared to before treatment, and the treatment group was significantly higher than the control group,with statistical significance (P<0.05). VAS score of 2 groups after treatment were significantly lower than before treatment,and VAS score of treatment group was significantly lower than that of control group after treatment,with statistical significance(P<0.05). The levels of blood calcium and serium inorganic phosphorus had no change in 2 groups;but the level of osteocalcin was significantly higher than before treatment,while the level of bone-specific alkaline phosphatase was significantly lower than before treatment,and the levels of osteocalcin and bone-specific alkaline phosphatase in treatment groups were significantly better than in control group,with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Jintiange capsules combined with Zoledronic acid injection in the treatment of postmenopausal osteoporosis patients with diabetes can significantly in-crease BMD,relieve pain and improve lab index levels. Moreover,it doesn’t increase the risk of ADR.

Objective To investigate the relationship between stromal tumor-infiltrating lymphocytes (TIL) and CD8 or FOXP3 positive lymphocytes in triple-negative breast carcinoma.Methods A total of 160 triple-negative breast carcinomas were collected from the First Affiliated Hospital of Nanjing Medical University during 2012 to 2014.All were surgical excision or biopsy specimens from patients without prior chemotherapy and radiotherapy.Histopathologic analysis of stromal TIL was performed on hematoxylin and eosin-stained sections,and MaxVision immunohistochemical method was used for detection of CD8 and FOXP3 protein expression.Results Stromal TILs were positively correlated with Ki-67 labeling index (P =0.002).The density of CD8 + cytotoxic T-lymphocyte (CTL) was negatively correlated with tumor size (P =0.009),and positively correlated with Ki-67 index (P =0.021).The density of FOXP3 + regulatory T-lymphocyte (Treg) was inversely correlated with the patient age (P =0.030),and positively correlated with histological grade (P =0.026).Stromal TILs were positively correlated with the density of CD8 + CTL (P =0.014).Conclusions The percentage of stromal TILs and density of CD8 + CTL are associated with tumor cell proliferation of triple-negative breast cancers.The density of FOXP3 + Treg is significantly associated with poor prognosis.Stromal TIL is positively correlated with the density of CD8 + CTL Stromal TIL may provide a potential marker for pathological diagnosis and a target for guiding adjuvant therapy in patients with triple-negative breast cancers.