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Objective:Nivolumab is one of the most common programmed death 1 （PD-1） inhibitors used as an immune checkpoint inhibitor （ICI）. It brings significant therapeutic effects but often accompanied by serious drug toxicity. The pulmonary toxicities of nivolumab are not clear. This study aims to systematically explore the nivolumab-associated pulmonary toxicities and provide reference for clinical treatment. Methods:Data were extracted from US Food and Drug Administration （FDA） Adverse Event Reporting System （FAERS） database from January 1， 2016 to September 30， 2019. Two types of disproportionality analysis， information component （IC） and reporting odds ratio （ROR）， were applied in nivolumab-associated pulmonary adverse events （AEs） signal detection. Results:A total of 28 489 309 records were extracted from FAERS database and 8 181 records were associated with nivolumab. Analysis was conducted in 179 AEs and 86 signals were detected. Notably， potent signals were detected in radiation pneumonitis （IC025： 3.99， ROR025： 17.25）， pneumonitis （IC025： 3.34， ROR025： 10.64） and bronchial fistula （IC025： 2.94， ROR025： 8.78）. Nivolumab-associated pulmonary toxicities were more frequently reported in dyspnoea （IC025： 0.50， ROR025： 1.44）， pneumonia （IC025： 0.08， ROR025： 1.07） and pneumonitis （IC025： 3.34， ROR025： 10.64）. Results of IC and ROR methods were similar to each other. Most pulmonary toxicities were observed in patients with non-small cell lung cancer （N=3 711， 32.13%）， malignant melanoma （N=1 658， 14.36%） and renal cell carcinoma （N=731， 6.33%）. Conclusion:Significant pulmonary toxicities were detected in patients treated with nivolumab. Thus， it is highly important for clinicians to be vigilant about nivolumab-associated pulmonary AEs and be prepared to take immediate action for patient safety.
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A survey on clinical skill application and training needs of general practitioners (GPs) was conducted in the community health service centers of Shanghai Changning District from March to May 2019. The heads of the medical/prevention departments of 10 community health service centers (CHS) in Changning District were invited to evaluate the application frequency of clinical skills and training needs of GPs. According to Residency Training Standards for General Practitioners (trial), Training Standards for Assistant General Practitioners (trial), Training Program for General Practitioners in Primary Medical and Health Institutions (trial), 369 clinical skills for general practitioners were included for evaluation. The application frequency of above 369 clinical skills among 198 general practitioners were evaluated and training needs were also assessed. The overall application frequency score of GPs for 369 clinical skills was 1.00 (0.30, 1.70) points, and the training needs score was 1.40 (1.10, 1.70) points. The application frequency of different clinical skills was positively correlated with training needs ( r=0.462, P<0.01). And the four-quadrant analysis results show that among the 369 clinical practice skills, 116 (31.4%) items were used by GPs with high frequency and high training needs, and 80 (21.7%) items were used with low frequency but high training needs. There were 45 (12.2%) items with high application frequency but low training needs, and 128 (34.7%) items with low application frequency and low training needs. The survey indicates that the training of clinical skills listed in the three major training standards or outlines should be strengthened in continuing education for general practitioners, and the practice skills with high application frequency and high training needs should be focused in training program to improve the quality, effectiveness and efficiency of training.
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Objective To obtain serological prevalence data for HBV markers in inpatients of Xi'an area with consequence of providing basis for nosocomial infection control and clinical stuff.Methods The serological markers of HBV (HBsAg,HBsAb,HBeAg,HBeAb,HBcAb) in serum of inpatients including 5 248 males and 5 345 females in 2015 were quantitatively detected by chemiluminescent analyzer ARCHITECT i4000SR.Results The infection rate of HBV was 7.01％ (743/10593) and there were 14 patterns of HBV serum markers in inpatients.Of all patterns of HBV infection in this study,there were 5.17 ％ (548/10 593) with HBsAg+ HBeAb+ HBcAb+,1.34 ％ (142/10 593) with HBsAg+ HBeAg+ HBcAb+,0.25％ (27/10 593) with HBsAg+HBcAb+ and 0.25％ (26/10 593) with other uncommon ones.Of all patterns of HBV convalescent stage,there were 21.02％ (2 227/10 593) with HBsAb+,13.71％ (1 452/10 593) with HBsAb+HBeAb+ HBcAb+,and 15.07％ (1 596/10 593) with HBsAb+HBcAb+.The percentage of five serum markers with negative was 31.38％ (3 324/10 593).There existed statistical difference for patterns of HBV serum markers concerning gender and different age groups,respectively (P＜0.05).The clinical departments with highest percentages of HBsAg-+-HBeAg+ HBcAb +-,HBsAg+ HBeAb+ HBcAb+ and HBsAb+ were department of gastroenterology with 7.39 ％ (36/487),department of gastroenterology with 16.43％ (80/487) and thoracic surgery one with 89.23％ (58/65),respectively.Conclusion This study provided clinical data of management and controlling the transmitting of HBV and promotion of HBV vaccination.Meanwhile it is necessary for government to take effective measures to reduce the infection rate of HBV in Xi'an area.
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Tripterygium glycosides preparation which extracted from the traditional Chinese herb Tripterygium wilfordii (TWHY), was widely used to treat the autoimmune diseases. Previous works demonstrated that TWHF had potent anti-inflammatory and immunosuppressive properties. But the different quality and high incident rate of side effects of different manufactures inhibited its clinical application. Since TWHF had been generally known to play a therapeutical effect by synergism of multiple constituents, it was necessary to build the relationship between the HPLC fingerprint and bioactivity so as to ensure the quality safety and efficacy. The HPLC fingerprint showed that description and content of peaks from different manufactures were diverse. Only 11 common peaks were found. In this study, mice spleen cells stimulated by Con A were used to test the proliferation inhibition bioactivity of TWHF preparations, which were incubated with 30, 15, 7.5, 3.75, 1.88 and 0.94 mg x L(-1) TWHF preparations for 48 h. The results showed that mice spleen cells proliferation was inhibited by all TWHF preparations significantly compared with the control group, which suggested the TWHF preparations showed immune suppress activity. The TWHF preparations from 7 manufacture showed different IC50 value, which might belong to different contents which showed in the HPLC fingerprint. Moreover, a relationship between the HPLC fingerprint and the bioactivity were established to identify important constituents by grey relational analysis (GRA). The result showed that all the contents were relative with the IC50, especially No. 5 and 10 peaks, but No. 1 peak, which was proved to be triptolide, had few contribute to the inhibition of mice spleen cells proliferation. The study of relationship between the HPLC fingerprint and the IC50 by GRA could help to investigate mechanism of bioactive and provide an evidence for the quantification of multi-constituents.
Subject(s)
Animals , Male , Mice , Anti-Inflammatory Agents , Pharmacology , Cell Proliferation , Chromatography, High Pressure Liquid , Drugs, Chinese Herbal , Pharmacology , Glycosides , Pharmacology , Mice, Inbred BALB C , Spleen , Cell Biology , Tripterygium , ChemistryABSTRACT
Objective: To investigate the immunosuppressive components in Leigongteng Duogan Tablet (LDT). Methods: High performance liquid chromatography (HPLC) was applied to establish the fingerprint for LDT from seven manufactures. The immunosuppressive effect of LDT was observed on Con A-induced mice spleen cells, and the cell proliferation and contents of IFN-γ were recorded. Then the partial least squares regression (PLSR) analysis was used to investigate its spectrum-effect relationship. Results: The HPLC fingerprint for LDT from seven manufactures was established, and 18 characteristic peaks were confirmed. The in vitro cell experimental results showed that the proliferation of mice spleen cells and secretion of IFN-γ were inhibited by all LDT significantly compared with the control group. According to the results of PLSR, No. 1, 2, 6, 7, 17, and 18 peaks were strongly related to the proliferation inhibition of mice spleen cells and No. 1, 2, 6, 7, 8, 9, 12, and 13 peaks were related to the secretion of IFN-γ. Conclusion: The No. 1, 2, 6, 7, 8, 9, 12, 13, 17, and 18 peaks are the principal immunosuppressive substances in LDT.
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Tripterygium wilfordii has been widely used in clinic for the treatment of autoimmune diseases ,such as ne‐phrotic syndrome ,rheumatoid arthritis ,systemic lupus erythematosus ,and the curative effect is significant .But it has toxic and side effects for liver ,kidney ,reproductive system ,etc .The side effects of Tripterygium wilfordii are the main obstacles for the usage and promotion .The literature reports about the clinical application and side effect of Tripterygium wilfordii are reviewed in this paper ,which provides reference for usage in clinic .
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<p><b>OBJECTIVE</b>To investigate the association between hyperglycemia and outcome in elderly patients with acute ST segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>This retrospective analysis was performed on 284 elderly patients (age > or = 60 years) with acute STEMI underwent primary PCI between January 2000 to April 2004 in our department. Patients were divided into 3 groups according to the level of blood glucose on admission: group A, < 7.8 mmol/L; group B, 7.8 - 10.9 mmol/L; group C, > or = 11.0 mmol/L.</p><p><b>RESULTS</b>(1) The proportion of female in group B and group C was greater than that of group A (33.3% vs. 26.5%, P < 0.01; 40.2% vs. 26.5%, P < 0.01). The hospital stay time of group B and group C was significantly longer than that of group A (16.0 days vs. 13.9 days, P < 0.05; 16.6 days vs. 13.9 days, P < 0.05). There were more patients with history of hypertension in group C than that in group A (72.1% vs. 54.9%, P < 0.01). (2) After PCI, the proportion of patients with TIMI myocardial perfusion grade (TMPG) 0-1 in group B and C was greater than that of group A (22.6% vs. 13.3%, P < 0.05; 34.1% vs. 13.3%, P < 0.05). The proportion of patients with TMPG 3 in group B and C was less than that in group A (74.3% vs. 84.4%, P < 0.05; 57.6% vs. 84.4%, P < 0.05). The complication rate of PCI was significantly higher in group C than in group A (42.5% vs. 20.6%, P < 0.01) and group B (42.5% vs. 26.6%, P < 0.01). IABP use was significantly more in group C than that in group A (19.5% vs. 4.9%, P < 0.01) and group B (19.5% vs. 6.4%, P < 0.01). (3) There were more patients with grade of Killip class > or = 2 in group C than that in group A (44.8% vs. 23.5%, P < 0.01) and group B (44.8% vs. 27.7%, P < 0.01). The in-hospital mortality rate (8.0% vs. 1.1%, P < 0.05) and one-year mortality rate (18.7% vs. 3.4%, P < 0.05) of group C were significantly higher than those in group A.</p><p><b>CONCLUSION</b>Hyperglycemia at admission was associated with poor tissue perfusion, cardiac function and prognosis in elderly patients with acute STEMI underwent primary PCI.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Blood Glucose , Hyperglycemia , Myocardial Infarction , Blood , Therapeutics , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To observe plasma soluble Fas/APO-1 concentration in patients with reperfusion arrhythmia immediately after coronary reperfusion in patients with acute myocardial infarction (AMI) and to investigate the impact of reperfusion arrhythmia on left ventricular (LV) remodeling in AMI patients. To observe the relationship between cardiomyocytes apoptosis with reperfusion arrhythmia in patients with acute myocardial infarction (AMI), and investigate the impact of reperfusion arrhythmia on left ventricular (LV) remodeling in patients with AMI.</p><p><b>METHODS</b>One hundred and fifty-six patients with AMI who received reperfusion therapy were selected as subjects. Fifty-eight patients underwent reperfusion arrhythmia within 24 hour after coronary reperfusion treatment (RA group). Ninety-eight patients did not occurred reperfusion arrhythmia (Non-RA group). Strepavidin-biotin ELISA was used to determine the soluble Fas/APO-1 plasma concentration at baseline, 7 day (d) and 2 - 4 week (W). All patients were followed up with scheduled evaluations of LV function and morphology with left ventriculography for 1 year.</p><p><b>RESULTS</b>1. It was later that the coronary reperfusion occurred in patients of RA group than that of Non-RA group, and the left anterior descending was more frequent infarct related artery (60.3%) than of Non-RA group (36.9%, P < 0.05). 2. The Fas/APO-1 levels in patients of RA group higher than those of Non-RA group at baseline [(13.82 +/- 4.36) microg/L vs (8.19 +/- 3.56) microg/L, P < 0.01]. 3. The highest level of Fas/APO-1 was on 7 d after AMI and the plasma levels of Fas/APO-1 in 2 - 4 W were slightly lower than those in 7 d in the two groups [RA group: (10.91 +/- 3.65) microg/L vs (14.26 +/- 4.98) microg/L, P < 0.05; Non-RA group: (4.69 +/- 1.87) microg/L vs (12.19 +/- 3.25) microg/L, P < 0.01]. However, the Fas/APO-1 level of 2 - 4 W in RA group was slightly higher than the level in Non-RA group [(10.91 +/- 3.65) microg/L vs (4.69 +/- 1.87) microg/L, P < 0.01]. 4. There was on difference between two groups in left ventricular ejection fraction (LVEF) and the left ventricular end-diastolic dimension (LVEDD) one week after AMI [LVEF: (47.7 +/- 9.6)% vs (49.2 +/- 8.9)%, P > 0.05; LVEDD: (59.7 +/- 10.3) mm vs (57.4 +/- 12.4) mm, P > 0.05]. 5. In the Non-RA group, the LVEF significantly increased from 1 W phase to the 1-year phase [from (49.2 +/- 8.9)% to (59.5 +/- 9.2)%, P < 0.05], but unchanged in the 58 patients without reperfusion arrhythmia [from (47.7 +/- 9.6)% to (49.9 +/- 10.1)%, P > 0.05]. The LVEF of Non-RA group was slightly higher than that of RA group at 1 year [(59.5 +/- 9.2)% vs (49.9 +/- 10.1)%, P < 0.05]. The LVEDD had no significant difference between two groups, but there was downtrend in the Non-RA group at 1 year after AMI.</p><p><b>CONCLUSION</b>Reperfusion arrhythmia was related with cardiomyocytes apoptosis in patients with AMI, and might influence left ventricular function and promote LV remodeling.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Apoptosis , Arrhythmias, Cardiac , Therapeutics , Myocardial Infarction , Pathology , Therapeutics , Myocardial Reperfusion , Myocardial Reperfusion Injury , Ventricular Remodeling , fas Receptor , BloodABSTRACT
<p><b>BACKGROUND</b>Hyperglycemia has been shown to be a powerful predictor of poor outcome after ST-segment elevation myocardial infarction (STEMI). This study aimed to evaluate the effect of admission glucose on microvascular flow after successful primary percutaneous coronary intervention (PCI) in patients with STEMI.</p><p><b>METHODS</b>Successful primary PCI was performed in 267 patients with STEMI. The maximum ST elevation of single electrocardiogram (ECG) lead before and 60 minutes after PCI was measured, and patients were then divided into 3 groups according to the degree of ST-segment resolution (STR): absent (<30%), partial (30% to 70%) or complete (> or =70%).</p><p><b>RESULTS</b>Of the 267 patients, 48 (18.0%) had absent STR, 137 (51.3%) experienced partial STR, and 82 (30.7%) had complete STR. The degree of STR decreased with increasing admission glucose levels (P=0.032), and patients with hyperglycemia (serum glucose level > or =11 mmol/L) were more likely to have absent STR (P=0.001). Moreover,hyperglycemia was an independent predictor of incomplete STR (odds ratio, 1.870; 95% confidence interval, 1.038 to 3.371, P=0.037).</p><p><b>CONCLUSIONS</b>Hyperglycemia on admission is associated with abnormal coronary microvascular reperfusion in patients with STEMI after successful primary PCI, which may contribute, at least in part, to the poor outcomes in these patients.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Methods , Electrocardiography , Glucose , Metabolism , Hyperglycemia , Blood , Pathology , Myocardial Infarction , Blood , Therapeutics , Odds RatioABSTRACT
<p><b>OBJECTIVE</b>To investigate the apoptosis effect of isothiocyanates (ITCS) on human liver cancer cells HepG-2, and its mechanism.</p><p><b>METHOD</b>HepG-2 cells were treated with different concentrations of ITCS. MTT assay was used to evaluate the influence of ITCS on cell proliferation. Flow cytometry was used to test ROS levels, intracellular mitochondrial transmembrane potential (deltapsim) , and hypodiploid apoptosis peak in HepG-2 cells.</p><p><b>RESULT</b>ITCS obviously inhibited proliferation of HepG-2 cells. When treated with 15, 30, 60, 120, 240 microg x mL(-1) of ITCS for 24 h, ROS levels were (23.1+/-1. 8)%, (53.3+/-3.3)%, (57.9+/-2.0)%, (79.9+/-3.4)%, (93.4+/-2. 6)% respectively; and deltapsim were (94.8+/-5.5)%, (91.8+/-5.4)%, (66.0+/-5.6)%, (65. 5+/-6.6)% and (44.3+/-2.7)% respectively; when treated with 60, 120, 240 microg x mL(-1) of ITCS for 48 h, cell apoptotic rates were (16.6+/-2.8)%, (21.9+/-4.4) % and (70.2+/-5.3) % respectively.</p><p><b>CONCLUSION</b>ITCS generates ROS in gastric cancer HepG-2 cells, which causes mitochondrial membrane permeabilization and deltapsim decrease, therefore, leads to apoptosis of HepG-2 cells.</p>
Subject(s)
Humans , Antineoplastic Agents, Phytogenic , Pharmacology , Apoptosis , Brassica , Chemistry , Cell Line, Tumor , Cell Proliferation , Isothiocyanates , Pharmacology , Liver Neoplasms , Metabolism , Pathology , Membrane Potential, Mitochondrial , Mitochondria, Liver , Physiology , Plants, Medicinal , Chemistry , Reactive Oxygen Species , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To study the effects of "half-conditioning", a modified postconditioning process, on myocardial injury induced by severe myocardial ischemia/reperfusion (I/R) in anesthetized dogs.</p><p><b>METHODS</b>Mongrel dogs of both sexes were subjected to 40 min ischemia (coronary blood flow reduced by 80% via controlled coronary stenosis). At the end of ischemia, dogs were randomly received one of the following treatments: (1) control, reperfusion for 3 h (n = 7); (2) post-conditioning, three cycles of ischemia 30 s followed by reperfusion for 30 s and then reperfusion for 3 h (n = 7); (3) half-conditioning, coronary blood flow recovered to 50% for 2 min, then 80% for 2 min, thereafter 100% for 3 h (n = 7). Electrocardiogram (ECG), arterial blood pressure and left ventricular pressure were monitored throughout the experiment. Plasma creatine kinase (CK) and lactate dehydrogenase (LDH) activity were measured spectrophotometrically. Myocardial necrosis was defined by TTC-staining.</p><p><b>RESULTS</b>Compared with control animals, arrhythmia incidence, LVEDP at 2 and 3 h reperfusion, CK and LDH were significantly reduced in animals received post-conditioning and half-conditioning treatments, infarct size as a percentage (%) of the area at risk was also significantly reduced by post-conditioning and half-conditioning treatments. No differences were observed in the post-conditioning and half-conditioning groups.</p><p><b>CONCLUSION</b>Half-conditioning exerts the same cardioprotective effects on post-ischemic hearts as postconditioning.</p>