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Objective:To investigate the prognostic value of systemic immune-inflammation index (SII) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods:The clinical data, including age, gender, complications, laboratory examination results post-admission, SII, model for end-stage liver disease (MELD) score, MELD-Na score, Child-Turcotte Pugh (CTP) score of HBV-ACLF patients treated in Huashan Hospital, Fudan University from January 2016 to August 2021 were retrospectively analyzed. The patients were divided into survival group and death group according to the outcome at 90 days of follow-up.Paired sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis.Pearson correlation was used to analyze the correlation between SII and the prognosis prediction model of HBV-ACLF. The area under the curve (AUC) was used to analyze the clinical efficacies of SII, MELD score, MELD-Na score and CTP score in predicting the prognosis of HBV-ACLF patients, and the optimal cut-off value of SII for predicting the prognosis of HBV-ACLF was calculated. Kaplan-Meier method was used for survival analysis. Results:A total of 140 patients with HBV-ACLF were included. There were 88 patients in the survival group, including 65 males and 23 females, with the age of (47.69±11.96) years. There were 52 cases in the death group, including 40 males and 12 females, with the age of (52.73±12.22) years. The age, aspartate aminotransferase, total bilirubin, serum creatinine, international normalized ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, SII, MELD score, MELD-Na score, CTP score and the incidence of infection in the death group were all significantly higher than those in the survival group, and albumin, lymphocyte count, platelet count, prognostic nutritional index in the death group were all significantly lower than those in the survival group, and the differences were all statistically significant ( t=-2.39, Z=-2.84, t=-4.81, Z=-2.15, Z=-4.91, Z=-3.47, Z=-3.36, Z=-3.83, Z=-4.69, Z=-4.56, Z=-6.31, χ2=24.96, t=3.06, t=3.03, Z=-7.57 and t=4.12, respectively, all P<0.05). Pearson correlation analysis showed that SII was positively correlated with CTP score ( r=0.272 7, P=0.001), MELD score ( r=0.365 8, P<0.001) and MELD-Na score ( r=0.381 1, P<0.001). The AUC of SII was the largest of 0.80, and 0.76 for MELD score, 0.74 for MELD-Na score and 0.73 for CTP score. The optimal cut-off value of SII was 447.49. Kaplan-Meier analysis showed that the 90 days survival rate of patients with SII≥447.49(38.60%(22/57)) was lower than that of SII<447.49 group (79.52%(66/83)), and the difference between the two groups was significant ( χ2=23.80, P<0.001). Conclusions:SII can be used to assess the severity and prognosis of HBV-ACLF patients. SII ≥447.49 indicates poor prognosis.
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ObjectiveEsophageal cancer is a common malignant tumor of the upper gastrointestinal tract， and has high incidence and mortality in China. Its incidence is increasing year by year， and survival rate is low， thus seriously threatening human life and health. To further explore the pathogenesis of esophageal cancer and its systematic and efficient diagnosis and treatment methods， the animal models of esophageal cancer was evaluated according to the animal model evaluation method previously established by our team based on the characteristics of its clinical symptoms of traditional Chinese and western medicine， and suggestions for model improvement were proposed. MethodThe existing animal models of esophageal cancer were summarized through China National Knowledge Infrastructure （CNKI） and Wanfang Data. The relevant indexes of the models were assigned， and their coincidence with the clinical diagnostic guidelines of traditional Chinese and western medicine for esophageal cancer was evaluated. ResultExcept the spontaneous animal model of esophageal cancer with high clinical coincidence adopted in few studies， the animal model induced by methylbenzylnitrosamine was in good agreement with the clinical data， which simulated the etiology and pathogenesis of esophageal cancer to a certain extent. The model partially reflected some indicators of clinical diagnosis in western medicine， and also indicated the body weight loss， purple nail and increased number of drinking in traditional Chinese medicine （TCM）. However， there was still a lack of differentiation of TCM syndromes. ConclusionOn the basis of the original model， the animal model induced by methylbenzylnitrosamine and the mouse model of xenogeneic gastric wall transplantation of human esophageal cancer cells were applied， which were intervened with the factors of phlegm and qi mutual obstruction syndrome， blood stasis and phlegm stagnation syndrome， Yin deficiency and internal heat syndrome and Qi deficiency and yang weakness syndrome， and were distinguished to reflect the performance of TCM syndrome. The animal model of esophageal cancer combined with TCM syndrome was thus obtained， which embodied the clinical symptoms of esophageal cancer in TCM， and the characteristics of the animal model combined with TCM syndrome， and simulated the clinical practice of traditional Chinese and western medicine， providing an accurate pathological model carrier for basic research.
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Objective:To investigate the effects of hippocampal injection of tyrosine kinase receptor binding protein B3(Ephrin-B3) agonist on spontaneous seizures and the expression of hippocampal secretory glycoprotein (Reelin) and phosphorylated adaptor protein (p-Dab1) in epileptic model rats.Methods:Seventy-eight rats were randomly divided into control group and model group according to body mass matching with 39 rats in each group.The rats in control group were fed normaly, and the rats in model group were established epilepsy model by intraperitoneal injection of lithium chloride pilocarpine. The hippocampal tissues were taken in the acute phase (7 days), quiescent phase (14 days) and chronic phase (60 days) after the successful induction of status epilepticus. The levels of Reelin protein and p-Dab1 protein in the hippocampal tissues of epileptic model rats and normal rats were detected by immunohistochemistry and Western blot.And thirteen rats were randomly selected at each time point. Another 48 rats were randomly divided into normal Fc-control group, normal EphB3-Fc group, epilepsy Fc-control group and epilepsy EphB3-Fc group, with 12 rats in each group. Rats in the first two groups were fed normally, and those in the latter two groups were established epileptic model. Seven days after modeling, all rats were injected into bilateral hippocampus with EphB3-Fc (Ephrin-B3 agonist) and FC control (control agent of Ephrin-B3 agonist) according to the grouping, once a day for 7 days. After administration, the changes of behavior and EEG were observed within two weeks. At the same time, the expression of Reelin protein and p-Dab1 protein were detected by immunohistochemistry and Western blot. SPSS 21.0 was used for statistical analysis, One-way ANOVA was used for multi group comparison, and Tukey's test was used for pairwise comparison.Results:The results of immunohistochemistry and Western blot showed that compared with the control group, the levels of Reelin and p-Dab1 protein in hippocampus of model group decreased significantly at 7, 14 and 60 days after epilepsy (all P<0.01). The results of immunohistochemistry showed that compared with epilepsy Fc-control group, the levels of p-Dab1 ((0.41±0.04), (0.58±0.06), P<0.05) in epilepsy EphB3-Fc group increased significantly.Western blot result showed that the level of p-Dab1 in epilepsy EphB3-Fc group increased compared with that of epilepsy Fc-control group (1.34±0.04), (2.26±0.10), P<0.01). Compared with epilepsy Fc-control group, epilepsy EphB3-Fc group showed less average seizure duration ((39.00±1.79)s, (26.50±1.87)s; t=23.21, P<0.01), less frequencies ((2.00±0.89), (0.50±0.55); t=2.32, P<0.01) and less latent period ((6.33±1.37)day, (12.50±1.87)day; t=2.52, P<0.01) in spontaneous recurrent seizures. Compared with epilepsy Fc-control group, epilepsy EphB3-Fc group showed lower average amplitude ((37.30±1.21)μV, (29.00±1.41)μV; t=25.14, P<0.01), less average seizure duration ((5.35±0.19)s, (2.35±0.19)s; t=3.13, P<0.01). Conclusion:Ephrin-B3 alleviated spontaneous recurrent seizures by upregulating Reelin and p-Dab1 in temporal lobe epilepsy rat.
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The pathology of sepsis is extremely complex. Pathogen invasion, inflammatory factors secretion, coagulation disorder and microcirculation disturbance lead to metabolic disorder and organ dysfunction. In recent years, immunometabolism has aroused continuous attention in aspect of nutrition therapy and immune intervention for sepsis. Nutrition metabolites include amino acids, fatty acids, and glucose metabolites, which are not only the nutritional ingredients, but also the regulators of innate immune and adaptive immune. Fatty acids and glucose metabolites are involved in regulation of immune response mainly via free fatty acid receptors and AMP-activated protein kinase/mammalian target of rapamycin (AMPK/mTOR) signaling pathway. Here, we summarized the research progress on the roles of nutrition metabolites in nutrition therapy and immune regulation during sepsis, which could provide a new direction for the development of metabolic therapy for sepsis.
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Objective:To observe the efficacy and safety of oral administration of low-molecular-weight collagen peptide on facial skin rejuvenation.Methods:A total of 66 female volunteers in Department of Dermatology, Beijing Friendship Hospital, Capital Medical University aged from 35 to 50 years old (average 42.89±4.44) from November 2018 to February 2019 were enrolled and randomly divided into two groups, 33 cases each. The testing group was given 5 g Su Yan Xin Ji collagen peptide for 12 weeks; the control group was given 5 g Tai Duo Jian collagen protein powder for 12 weeks. The effects were evaluated and analyzed using VISIA and CK complexion analysis system before and after 1, 2, 4 , 12 weeks of oral administration collagen; meanwhile, the volunteers' overall satisfaction and adverse reactions were also recorded.Results:In total, 61 volunteers completed the study. After 12 weeks of oral administration, the skin hydration of testing group and control group were all increased (65.41±10.60 vs 59.82±9.26), the transepidermal water loss, wrinkles, textures, pores, red areas and porphyrin were all decreased (19.19±4.24 vs.21.50±5.10; 7.38±3.67 vs. 8.98±6.67; 5.55±3.07 vs.6.60±4.84; 16.94±9.30 vs. 17.95±8.85; 21.92±4.60 vs. 22.11±5.34; 10.31±7.03 vs. 11.62±8.58). There were statistically significant differences between the 7 parameters before and after oral administration ( P<0.05). The difference of skin hydration between the testing and control group was statistically significant ( t=2.317, P=0.024). Although there was no statistical difference among the other six parameters, the improvement degree of the testing group was better than that of the control group. Surface spots, UV spots and brown spots of two groups showed no significant difference before and after treatment. Overall satisfaction of the testing group and the control group were 86.67% vs. 61.29% with significant difference 12 weeks after treatment ( χ2=5.074, P=0.024), while there were no significant differences in incidence of adverse reactions between two groups ( P>0.05). Conclusions:Oral administration of low-molecular-weight-collagen peptide can improve skin textures, moisturize skin with high overall satisfaction. It is an effective method of facial rejuvenation and better than that of collagen protein powder.
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Objective Random allocation concealment is important in ensuring high-guality randomized controlled clinical trial.In this paper , we aimed to design a more convenient and effective two couplet random allocation method through improving the random allocation concealment technology which uses the envelope method . Methods According to the randomized sequence , a two-couplet random allocation should be prepared for every subject and bound into a book in order , which named random assignment book with cover and instructions .The first couplet is to collect the enroll information and the second couplet is to show the allocation informa -tion.The serial numbers of the two couplets which around sealant are the same , and leave blank at the same areas of the two couplets for signing the enter information .The content of the first couplet can be completely copied to the second couplet .In order to avoid expo-sing the allocation information in advance , the back of the second couplet should be black-printed. When the subjects are sure qualified, the researchers selected the corresponding two couplet in a sequential order .Exposing the allocation infromation in the second couplet, and the subjects will be allocated to the group designated on the second couplet .This random allocation book should be entrusted to professional printing mechanism ,printing according to the random assignment sequence table and in the strict quality control .For the multicenter clinical trials , it can be printed in parts . Results The method has been implemented in nearly ten randomized controlled trials and obtained the consistent high praise . Conclusion The random allocation book method is easy to produce , simple operation and convenient in monitoring , which can effectively achieve the random allocation concealment in a clinical trial as well as having a sig -nificantly practical value in ensuring the quality of randomization .
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Objective To understand the coverage of iodized salt and the iodine nutritional status of schoolchildren in Hongkou District of Shanghai City and to provide a basis for adjusting corresponding intervention measures.Methods From 2012 to 2016,according to the "Shanghai Iodine Deficiency Disease Surveillance Program",a street was chosen from five directions as east,west,south,north and centre in Hongkou District.According to the annual monitoring plan,a certain amount of residents or schoolchildren aged 8-10 were chosen for monitoring,collecting salt samples from residents or children's home to detect salt iodine,and collecting urine samples of children to detect urinary iodine level (which was not tested in 2013).Determination of iodine salt was based on "Determination of Iodine by the General Test Method for the Salt Industry" (GB/T 13025.7-2012),urinary iodine determination was based on "Arsenic and Cerium Catalytic Spectrophotometric Determination of Iodine in Urine" (WS/T 107-2006).Results From 2012 to 2016,a total of 1 550 edible salt samples were tested,including 847 qualified iodized salts,299 unqualified iodized salts and 404 non-iodized salts,the coverage of iodized salt was 73.9％,and the consumption rate of qualified iodized salt was 54.6％.A total of 591 urine samples were tested in 2012,2014-2016.The median of urinary iodine was 177.2 μg/L;of which ＜ 100 μg/L was 103,accounting for 17.4％;100-199 μg/L was 248,accounting for 42.0％;and ≥300 μg/L was 91,accounting for 15.4％.Conclusions The residents in Hongkou District of Shanghai City do not meet the target of iodized salt coverage and consumption rates of qualified iodized salt.The average urinary iodine level of schoolchildren aged 8-10 years has reached the national standard for eliminating iodine deficiency disorders;we should further improve the consumption rate of qualified iodized salt.
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3-phosphoinositide dependent kinase-1 (PDK1) has been shown to be a critical regulator of the PI3K-Akt pathway.PDK1 can activate Akt and participates in the activation of PI3K-Akt signaling pathway to promote tumor development,invasion and metastasis.At present,it has been found that PDK1 is highly expressed in head and neck cancer,multiple myeloma,pancreatic cancer,esophageal cancer,colon cancer and other malignant tumors.Thereby inhibiting PDK1 overexpression may provide a new breakthrough for the treatment of malignant tumor.At present,many kinds of PDK1 inhibitors have been put into production,which plays an important role in tumor therapy.
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ObjectivesTo investigate the effect of thyroid hormone on the expression of deiodinase and myelin basic protein in brain tissue of neonatal rats with germinal matrix-intraventricular hemorrhage (GM-IVH), and its nerve protective effect.Methods Sixty premature rabbits of gestational age 29 days were randomly divided into control, model and intervention groups. The prema-ture rabbits in model and intervention groups were given intraperitoneal injection of 50% glycerol to establish GM-IVH animal model and the premature rabbits in control group were given the same dose of saline. The GM-IVH was screened by cranial ultrasound. The premature rabbits with GM-IVH in intervention group were given intraperitoneal injection of triiodothyronine and the other two groups were given the same dose of saline. At 3 days, 7 days and 14 days after birth, the premature rabbits were killed and the brain tissue were quickly separated. The expression of type 2 iodothyronine deiodinase (D2) and type 3 iodothyronine deiodinase (D3) of periventricular zone tissue were detected by western blot method. The expression of myelin basic protein (MBP) were detected by immunohistochem-ical method.ResultsThe expression of D2 in brain tissue increased gradually in three groups. At the same time point, the expression of D2 was the lowest in the model group, the highest in the control group, and the middle in the intervention group. The differences of D2 among three groups were statistically signiifcant (allP<0.001). The expression of D3 increased gradually in the control and model groups, while it was the highest in the intervention group at day 7. At the same time point, the expression of D3 in the control group was the lowest, it was higher in intervention group than that in the model group at 3 days, then it was higher in the model group than that in the intervention group. The differences of D3 among three groups were statistically signiifcant (allP<0.001). The expression of MBP increased gradually in the control and intervention groups, and it decreased gradually in the model group. At the same time point, the MBP was the lowest in the model group, it was the highest in the control group, and it was the middle in the intervention group. The differences of MBP among three groups were statistically signiifcant (P<0.001).ConclusionsThe expressions of D2 and MBP in the brain tissues of premature rabbit with the GM-IVH increased while the expression of D3 decreased in some extent after thyroxine intervention.
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Status epilepticus (SE) is one of the common medical emergencies of the pediatric age group.It may lead to serious and even irreversible neurological abnormalities,even death,if not diagnosis and treatment properly.To recognise etiology,rise factors,seizure type,treatment,outcome and the correlation between each other of children with status epilepticus are significant for management.This paper aimed to review recent epidemiological studies on children with status epilepticus,in order to provide evidences for the current clinical practice and further research.
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Objective:To establish the quality control method for compound Jieyu granules. Methods:Liquorice was identified by TLC. saikosaponin a, Saikosaponin d and rutin were determined by HPLC. Results:The spots on TLC plates were clear without any in-terference. The linearity was achieved within the range of 0. 508-16. 200 μg (r=0. 999 8) for saikosaponin a, 0. 503-16. 100 μg(r=0.999 7) for saikosaponin d, and 0.130-4.250 μg(r =0.999 9) for rutin. The average recovery was 99.7%(RSD =2.03%), 99. 8%(RSD=1. 44%) and 102. 6%(RSD=1. 40%), respectively. Conclusion:The method is simple, reliable and accurate, and can be applied as the quality control method for compound Jieyu granules.
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Objective To investigate the accuracy of serum neuron-specific enolase (NSE)predicting malignant middle cerebral artery infarction(mMCAI).Methods A total of 40 patients with acute massive cerebral infarction within 24 hours after symptom onset were recruited.Blood samples were collected at 24,36 and 48 hours after symptom onset.Serum NSE concentration was determined by automatic electrochemiluminescence analyzer.mMCAI was defined as hernia signs in clinical practice,and CT/ MRI showed mass effect.The receiver operating characteristic curve was used to analyze the accuracy of serum NSE concentration in predicting mMCAI at 3 time points.Results Sixteen patients(40%)developed mMCAI.The serum NSE concentration for predicting the accuracy of mMCAI was poor at 24 hours after symptom onset;the serum NSE concentration for predicting the specificity of mMCAI was high (96%)at 36 hours after symptom onset,but the sensitivity was lower(69%);the serum NSE concentration for predicting the specificity(92%)and sensitivity(88%)of mMCAI were high at 48 hours.Conclusions The serum NSE conoentration and its dynamic changes may predict the occurrence of mMCAI,and the predicting time points are appropriate from 36-48 hours after symptom onset.
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[Objective] To investigate the changes of CD4~+ CD25~+ regulatory T cells (Tr) in peripheral blood and their relation with their body mass index (BMI) of children with acute attack asthma. [Methods] Peripheral blood was obtained from 70 children with acute attack asthma, 30 remission children, and 50 normal control children. Then 70 children with acute attack asthma, were divided by normal weight group (40 cases) and overweight group (30 cases). The levels of CD4~+CD25~+Tr of the patients were tested by flow cytometry (FCM), and their BMI were calculated. [ Results] The levels of CD4~+ CD25~+ Tr [(6.17± 1.72)%] in acute attack group were lower than that in remission group [(7.56±1.48)%] or that in the control group [(7.13± 1.48)%] (P<0.05), but no difference between that in the remission and that in the control (P>0.05). The CD4~+CD25~+Tr of asthmatic children with normal weight [(6.34±1.71)%] was higher than that of asthmatic children with overweight [(4.74±1.20)%] (P<0.05). There was a remarkably negative correlation between the level of CD4~+ CD25~+ Tr of asthmatic children [(6.17±1.72)%] and the BMI (16.00±2.14) (r_p=-0.814, P<0.05). [Conclusion] The levels of CD4~+ CD25~+Tr are remarkable decrease in attack asthmatic children, and more decrease in overweight patients. There is remarkably negative correlation between the levels of CD4~+CD25~+ Tr in peripheral blood of attack asthmatic children and their BMI.
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Objective To investigate the possibility and accuracy of predicting malignant middle cerebral artery infarction (mMCAI) with bedside electroencephalography (EEG). Methods Thirty-five patients with massive hemispheric infarction (MHI) underwent bedside EEG monitoring within 48 h of onset. The EEG indicators were interpreted blindly, and the clinical, laboratory and imaging parameters were analyzed. The patients were divided into mMCAI group and non-mMCAI group according to whether they had occurred mMCAI or not within 7 days of onset. The differences of EEG indicators, clinical, laboratory and imaging parameters between the 2 groups were compared. When the parameters of significant difference and statistical significance appeared the odds ratio (OR) of occurring mMCAI were analyzed, and their accuracy of predicting mMCAI was calculated. Results Of the 35 patients with MHI, 20 were in the mMCAI group and 15 were in the non-mMCAI group. There were significant differences in the EEG indicators (infarction on the contralateral side, including disintegration of occipital α rhythm, generalized slow-wave, dominant frequency wave low amplitude, regional attenuation without delta [RAWOD]pattern, and absence of EEG reactivity), clinical parameters (nausea accompanied with vomiting), and imaging parameters (the infracted area more than the entire MCA territory, and midline shifting 3 to 5 mm at the level of septum pellucidum) between the 2 groups (P < 0. 05). Of those, the risk of mMCAI was the highest in patients with disintegration of occipital a rhythm on the contralateral side of infarction (P = 22. 67, 95% CI 3. 89-132. 10). The sensitivity of predicting mMCAI was 85. 0%, the specificity was 80.0%, the positive predictive value was 85.0%, and the negative predictive value was 80. 0%, which were superior to other EEG indicators and clinical or imaging parameters. Conclusions Bedside EEG indicators can early predict mMCAI, moreover, the predictive accuracy is superior to the clinical and imaging parameters.
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Objective To evaluate feasibility and reliability of using Simplified Acute Physiology Score Ⅱ (SAPS Ⅱ)in predicting mortality in critically ill patients with neurological diseases.Methods All 653 patients hospitalized in neurological intensive care unit (N-ICU) from Jan 2005 to Dec 2007 were retrospectively studied.SAPSⅡ scores were scaled upon admission at 24,48 and 72 h,and possibility of hospital mortality (PHM) was calculated based on SAPS Ⅱ score.Neurological diseases diagnosis made initially at time of hospitalization was classified into five categories:intracranial hemorrhage,cerebral infarction,neurologic infection,neuromuscular diseases and other neurologic diseases.At each of four time points,the SAPSⅡscores were compared between the survival group and death group,and the relationship of SAPS Ⅱ score and prognosis were analyzed.The calibration of the SAPS Ⅱ were accessed with the Hosmer-Lemeshow goodness-of-fit chi-squared statistic and the discrimination with area under the receiver operating characteristic curve (AUROC).Multivariate logistic regression was used to analyze the relationship between disease category and prognosis.Results SAPS Ⅱ scores in the death group (46.53±12.22,47.28±13.84,48.58±14.18 and 49.06±14.61)at each time point were significantly higher than those in the survival group (34.70±11.78,30.28±12.24,29.79±12.36 and 29.69±12.96;t=11.12,14.02,14.43 and 13.49 at 0,24,48 and 72 h,respectively,P＜0.01).Furthermore,univariate logistic regression analyses demonstrated that SAPS Ⅱ score was correlated with prognosis (OR=1.080,1.100,1.109,1.100 at 0,24,48 and 72 h,respectively,P＜0.01).The scores at 48 and 72 h were more accurate in predicting mortality.SAPS Ⅱ had good calibration at each time points (x2=5.305,7.557,6.369 and 8.540,P＞0.05),however,the consistency of expected mortality with observed mortality was satisfactory only at 48 and 72 h(82.6%,83.4%),so was the discrimination ( AUROC=0.825,0.847 respectively).There was no correlation between disease categories and outcome.Conclusion SAPS Ⅱ scoring,best evaluated at 48 and 72 h after hospitalization,can be used as a reliable predictor of probability of mortality in patients hospitalized in N-ICU and prediction can be applied in these patients with all different neurology diseases.
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AIM: To investigate the effect of glucocorticoid inhalation on the levels of CD4~+CD25~+ regulatory T cells in peripheral blood of asthmatic children. METHODS: Glucocorticoid inhalator was inhaled by 70 children with attack asthma. The levels of CD4~+CD25~+ Tr in peripheral blood of asthmatic children were tested by flow cytometry (FCM). RESULTS: The CD4~+CD25~+ Tr levels in peripheral blood of asthmatic children were (5.62% ± 1.29% ) and (7.05% ± 1.61%) before and after of regulated glucocorticoid inhalation, respectively (P<0.01). The Tr levels were (7.56% ± 1.88% ) , (7.09% ± 1.23% ) and (6.11% ± 1.96% ) in the complete control group, part control group and poor control group, respectively ( P < 0.05 ). The Tr level in formal treatment group (7.05% ±1.61%) was higher than that in irregular treatment group ( 5.91 % ± 1.76% ), P < 0.01.CONCLUSION: The level of CD4~+CD25~+ Tr is remarkable increased by regulated glucocorticoid inhalation, and the level of Tr can reflect the effects of glucocorticoid inhalation.
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in order to maintain a normal temperature range.