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Objective:To construct and verify the occurrence model of acute respiratory distress syndrome (ARDS) using lung injury prediction score (LIPS) combined with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and oxygenation index (PaO 2/FiO 2). Methods:Using a prospective cohort study method, 244 patients with complete medical records who were admitted to the intensive care unit (ICU) of Peking University Third Hospital from December 2020 to July 2022 were selected as research objects according to the inclusion and exclusion criteria. They were divided into training set (173 cases) and validation set (71 cases). Patients' gender, age, body mass index (BMI), various causes (shock, sepsis, craniocerebral injury, pulmonary contusion, multiple trauma, aspiration, pneumonia, acute abdomen, hypoproteinemia, acidosis, major surgery, etc.), underlying diseases (diabetes, malignant tumor, cerebrovascular disease, liver disease, kidney disease) and laboratory test indicators were collected. According to the above data, the LIPS score, APACHE Ⅱ score, sequential organ failure assessment (SOFA) and PaO 2/FiO 2, etc within 24 hours after admission to the ICU were calculated. Univariate analysis was used to screen the influencing factors for the occurrence of ARDS, and the factors with P < 0.2 were included in the multivariate Logistic regression analysis to screen out the independent predictive factors for the occurrence of ARDS. According to the results of multivariate Logistic regression analysis, the risk score of patients with ARDS was obtained to construct the risk prediction model of ARDS, the receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated. The established ARDS prediction model was externally validated, and ROC curves were drawn to evaluate the predictive accuracy of the prediction model for the occurrence of ARDS in critically ill patients, and the AUC of the validation set was calculated to analyze the predictive performance of each risk factor on the occurrence of ARDS. Results:A total of 173 patients were enrolled in the training set, including 121 patients without ARDS and 52 patients with ARDS; 77 cases of acute abdomen, 64 cases of sepsis, 60 cases of shock, 51 cases of acidosis, 40 cases of hypoproteinemia, 37 cases of diabetes, 34 cases of craniocerebral injury, 34 cases of abnormal liver function, 28 cases of multiple trauma, 23 cases of malignant tumor, 23 cases of spinal orthopedic surgery, 17 cases of obesity, 12 cases of pneumonia, 11 cases of pulmonary contusion, and 7 cases of chronic kidney disease, chemotherapy in 6 cases, and aspiration in 2 cases. The rates of shock, sepsis, acute abdomen, acidosis, abnormal liver function, lung contusion, pneumonia and aspiration, gender, age, LIPS score, APACHE Ⅱ score, and SOFA score in the ARDS group were significantly higher than those in the non-ARDS group (all P < 0.05), moreover, PaO 2/FiO 2 ratio was significantly lower than that of non-ARDS group ( P < 0.01). Multivariate Logistic regression analysis showed that LIPS score, APACHE Ⅱ score, and PaO 2/FiO 2 ratio were independent risk factors for ARDS in ICU patients with high risk factors for ARDS, and the odds ratio ( OR) was 1.768 [95% confidence interval (95% CI) was 1.380-2.266], 1.242 (95% CI was 1.089-1.417), 0.985 (95% CI was 0.978-0.991), all P < 0.05. ROC curve analysis showed that the AUC of the ARDS prediction model training set was 0.920, the sensitivity was 86.5%, and the specificity was 86.8%; the AUC of the verification set was 0.896, the sensitivity was 96.8%, and the specificity was 76.6%. Conclusion:LIPS score, APACHE Ⅱ score and PaO 2/FiO 2 are independent risk factors for the occurrence of ARDS in ICU patients with high risk factors for ARDS. The ARDS risk prediction model established based on these three indicators has a good predictive ability for the occurrence of ARDS in critically ill patients, wihich needs to be verified by multicenter cohort studies.
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Acute respiratory distress syndrome (ARDS) is a common critical disease in clinic, which refers to acute hypoxic respiratory failure caused by various insults, with bilateral fluffy infiltrates on chest radiography. It is reported that gender may play a critical role in the occurrence, severity, and outcomes of ARDS. Nevertheless, gender difference in ARDS is still controversial because of the complexity of the disease. This paper summarized the sex difference in epidemiology of ARDS according to different etiologies such as sepsis, trauma and respiratory viruses, and discussed gender-bias in the occurrence, severity and outcomes of ARDS. Moreover, we clarified briefly the mechanism that may contribute to the gender-bias to provide novel ideas for clinical treatment of ARDS.
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ObjectiveThis study investigated the mechanism of Wenjingtang in the prevention and treatment of endometriosis （EMT） from the perspective of regulating hypoxia stress and mitochondrial function. MethodPrimary human endometrial stromal cells （ESCs） form ectopic endometrial tissues were isolated and cultured， the cells were divided into control group （Control）， 5% control serum group （5% KBXQ）， 10% control serum group （10% KBXQ）， 5% Wenjingtang serum group （5% WJTXQ） and 10% Wenjingtang serum group （10% WJTXQ）. ESCs in different groups were detected for proliferation by methyl thiazolyl tetrazolium （MTT） assay， mRNA and protein expression of hypoxia inducible factor-1α （HIF-1α） by real-time fluorescent quantitative polymerase chain reaction （Real-time PCR） and Western blot analysis， mitochondrial ultrastructure by transmission electron microscope， mitochondrial function ［mitochondrial membrane potential， mitochondrial membrane potential（MMP） and cytochrome C（Cyt C） content］ and apoptosis （cell membrane permeability， nuclear fluorescence intensity， nuclear size and cell counts） by high content screening （HCS） assay， apoptosis rate by flow cytometry， and proteins of B-cell lymphoma-2 （Bcl-2） associated X （Bax）， Bcl-2 and cleaved cysteinyl aspartate specific proteinase-3 （cleaved Caspase-3） by Western blot. ResultCompared with Control group， the 5% KBXQ and 10% KBXQ groups showed increased cell viability （P<0.01）， there was no significant change in HIF-1α mRNA and protein expression， transmission electron microscopy showed that the mitochondrial cristae were obvious and the inner and outer membranes of mitochondria were clear， HCS multichannel fluorescence staining showed that there were no significant changes in the expression of MMP， Cyt C and cell membrane permeability， and the nuclei showed uniform light staining， there were no significant changes in apoptosis rate， cleaved Caspase-3 protein expression and Bax/Bcl-2 ratio. Compared with Control group and corresponding concentration KBXQ group， the 5% WJTXQ and 10% WJTXQ group showed decreased cell viability （P<0.01） and HIF-1α mRNA and protein levels （P<0.05，P<0.01）， the ultrastructure of mitochondria was destroyed， some mitochondria were swollen and the cristae were blurred， moreover， decreased MMP and up-regulated Cyt C release （P<0.05，P<0.01）， increased cell membrane permeability （P<0.01）， and apoptosis characteristics included nuclear pyknosis， DNA agglutination in nucleus and decrease of cell numbers were observed （P<0.05，P<0.01）， increased apoptosis rate （P<0.01）， which was consistent with the results of HCS analysis， and up-regulated expression levels of cleaved Caspase-3 protein and Bax/Bcl-2 ratio （P<0.05，P<0.01）. ConclusionIn conclusion， the results suggest that Wenjingtang can improve hypoxia stress via down-regulating HIF-1α expression in ectopic ESCs， and inhibit cell proliferation， reduce mitochondrial biological activity and induce apoptosis， which might be the internal mechanism of Wenjingtang in preventing and treating EMT.
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Acephalic spermatozoa syndrome (ASS) is one of the most severe spermatogenic failures of all infertility in men. The cognition of ASS has experienced a tortuous process. Over the past years, with the in-depth understanding of spermatogenesis and the emergence of new genetic research technologies, the unraveling of the genetic causes of spermatogenic failure has become highly active. From these advances, we established a genetic background and made significant progress in the discovery of the genetic causes of ASS. It is important to identify pathogenic genes and mutations in ASS to determine the biological reasons for the occurrence of the disease as well as provide genetic diagnosis and treatment strategies for patients with this syndrome. In this review, we enumerate various technological developments, which have made a positive contribution to the discovery of candidate genes for ASS from the past to the present. Simultaneously, we summarize the known genetic etiology of this phenotype and the clinical outcomes of treatments in the present. Furthermore, we propose perspectives for further study and application of genetic diagnosis and assisted reproductive treatment in the future.
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Humans , Male , Infertility, Male/pathology , Membrane Proteins/genetics , Mutation , Spermatogenesis/genetics , Spermatozoa/pathologyABSTRACT
Acid-sensing ion channels (ASICs), the main H
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OBJECTIVE@#To study the use of Chinese medicine (CM) in cancer patients in southern China.@*METHODS@#A total of 1,950 cancer patients finished questionnaires in four provinces in southern China. The survey included socio-demographic and clinical characteristics of participants, dosage forms, efficacy, and side effects.@*RESULTS@#The study results showed that cancer patients with higher education (>12 years) were more likely to accept the treatment of Chinese herbs. There were 54.61% (1,065 cases) of patients chose Chinese herbs for the initial treatment and 14.46% (282 cases) chose Chinese herbs as monotherapy. Most patients (54.51%, 1,063 cases) continuously used CM for more than 6 months, and a few of them (212 cases) used CM for up to 3 years. All kinds of dosage forms of CM had been used, including CM decoction, CM patent prescription and CM injection. Concerning the efficacy in the view of patients, 40.31% (786 cases) believed that it would be effective to take Chinese herbs before they starting the anti-cancer treatment, and the percentage increased to 81.08% after 1-month CM treatment. The effect of Chinese herbs was mainly demonstrated by symptom relief and improvement of quality of life, and 8.31% (162 cases) of patients experienced control of tumor growth and decreased tumor markers. Furthermore, only 14.31% (279 cases) participants reported that they experienced side effects during CM treatment.@*CONCLUSION@#This large scale investigation reflects the current situation of domestic CM usage objectively and comprehensively, which might provide new ways for cancer treatment.
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Objective:To observe the effect of fluid therapy on volume and coagulation function in patients with severe postpartum hemorrhage during cesarean section of placenta accreta under the guidance of inferior vena cava diameter (IVCD) and inferior vena cava collapse index (IVC-CI).Methods:A prospective randomized controlled study was conducted in 60 pregnant women with severe postpartum hemorrhage (blood loss ≥ 1 000 mL) who were hospitalized for delivery or referred for delivery in the Peking University Third Hospital from December 2018 to July 2019. The patients were divided into routine fluid replacement group and goal-oriented fluid resuscitation group (goal-oriented fluid replacement therapy was given) according to the different ways of fluid replacement. The hemodynamics, blood gas analysis, coagulation function, total fluid replacement, urine volume, prognosis, intraoperative vasoactive drugs utilization rate and postoperative adverse events were recorded before skin incision, after the fetus delivered, postpartum hemorrhage and at the end of operation, and the differences of these indices between the two groups were compared.Results:① Hemodynamics: the heart rate (HR) of the two groups were reached the peak during postpartum hemorrhage, but there was no significant difference in HR at each time point between the two groups. The mean arterial pressure (MAP) was decreased at first and then increased in both groups, and reached the trough at postpartum hemorrhage, but the MAP in the goal-oriented fluid resuscitation group was significantly higher than that in the routine fluid replacement group [mmHg (1 mmHg = 0.133 kPa): 75.6±10.7 vs. 69.2±8.9, P < 0.05]. In the goal-oriented fluid resuscitation group, the central venous pressure (CVP) was increased slightly after the fetus delivered and then stabilized, while in the routine fluid replacement group, the CVP was increased at first and then decreased, and reached the peak in postpartum hemorrhage. During postpartum hemorrhage, CVP in the goal-oriented fluid resuscitation group was significantly lower than that in the routine fluid replacement group [cmH 2O (1 cmH 2O = 0.098 kPa): 9.5±3.9 vs. 11.4±3.4, P < 0.05]. ② Arterial blood gas: partial pressure of oxygen (PaO 2) and partial pressure of carbon dioxide (PaCO 2) in arterial blood at the end of operation in both groups were higher than those in postpartum hemorrhage. There was no significant difference in PaO 2 at the end of operation between the goal-oriented fluid resuscitation group and routine fluid replacement group (mmHg: 189.3±100.5 vs. 240.2±126.3, P > 0.05). The PaCO 2 in the goal-oriented fluid resuscitation group was significantly lower than that in the routine fluid replacement group (mmHg: 34.6±4.6 vs. 36.8±4.1, P < 0.05). The lactic acid (Lac) at the end of operation of the goal-oriented fluid resuscitation group was significantly lower than that of the routine fluid replacement group (mmol/L: 2.2±0.6 vs. 2.6±1.1, P < 0.05). ③ Liquidintake and output volume: the total infusion volume, crystal fluid infusion volume and suspended red blood cell infusionvolume in the goal-oriented fluid resuscitation group were significantly less than those in the routine fluid replacement group [total infusion volume (mL): 3 385.9±1 144.1 vs. 4 448.3±1 194.4, crystal infusion volume (mL): 2 635.6±789.7 vs. 3 160.0±860.3, suspended red blood cell input volume (mL): 695.6±366.2 vs. 911.1±284.7, all P < 0.05], and the utilization rate of vasoactive drugs in the goal-oriented fluid resuscitation group was decreased significantly during operation [13.3% (4/30) vs. 60.0% (18/30), P < 0.05]. The amount of bleeding in the goal-oriented fluid resuscitation group was also significantly less than that in the routine fluid replacement group (mL: 1 451.7±373.8 vs. 1 725.9±372.8, P < 0.05), but there was no significant difference in urine volume between the goal-oriented fluid resuscitation group and the routine fluid replacement group (mL: 369.0±262.7 vs. 485.0±286.8, P > 0.05). ④ Coagulation function: at the end of operation, the prothrombin time (PT) in the goal-oriented fluid resuscitation group was significantly shorter than that in the routine fluid replacement group (s: 10.9±0.6 vs. 11.2±0.6), and the fibrinogen (Fib) in the goal-oriented fluid resuscitation group was significantly higher than that in the routine fluid replacement group (g/L: 3.7±0.5 vs. 2.9±0.8), and the differences were statistically significant (both P < 0.05).⑤ Prognostic index: compared withthe routine fluid replacement group, the proportion of patients transferred to intensive care unit (ICU) at the end of operation in the goal-oriented fluid resuscitation group was significantly lower [16.7% (5/30) vs. 66.7% (20/30), P < 0.05], and ICU length-of-stay was significantly shorter [hours: 0 (0, 24) vs. 24 (0, 24), P < 0.05], but there was no significant difference in the incidence of disseminated intravascular coagulation (DIC), acute renal injury (AKI) or hysterectomy between the goal-oriented fluid resuscitation group and the routine fluid replacement group [the incidence of DIC: 0% (0/30) vs. 6.7% (2/30), the incidence of AKI: 0% (0/30) vs. 3.3% (1/30), the hysterectomy rate: 10.0% (3/30) vs. 26.7% (8/30), all P > 0.05]. Conclusion:Fluid resuscitation guided by IVC-CI can effectively reduce the volume of blood and fluid transfusion and blood loss in patients with severe postpartum hemorrhage and improve their blood coagulation function.
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Objective:To investigate the perfection and improvement of the execution of integrative medicine therapy in severe tetanus therapy, to successfully control tetanus severe spasms, autonomic dysfunction and prevent lethal side-effect of prolong and high-dosage sedative-muscle-relaxant therapy, resulted in significant reduction of mortality of tetanus.Methods:Symptoms, treatments and outcome of tetanus patients admitted to Peking University Third Hospital from 1965 to 2020 were reviewed. Patients were classified with Ablett classification. The cases of Ablett grade Ⅲ and Ⅳ were severe tetanus. The patients were divided into two groups according to whether they were treated together with traditional Chinese medicine (TCM) simultaneously during the standard tetanus treatment; the patients in the TCM group were divided into the tetanus TCM medication group and the non tetanus TCM medication group according to the medicine provided whether was in accord with the conventional tetanus TCM prescriptions. The mortality of each group was calculated. In addition, one survived and one deceased case with severe convulsion, autonomic nerve dysfunction (Ablett grade Ⅳ) were selected, combined with the treatment methods and curative effects, the types, use methods and outcomes of Chinese and Western medicine were analyzed.Results:The 46 tetanus cases were treated with Western medicine. Twenty-two of them, TCM were applied. Fifteen of the 22 cases took the TCM prescription which was accord with the conventional tetanus prescription. The mortality of the 46 cases was 21.7% (10/46). The number of non-TCM group was 24 cases, with mortality of 20.8% (5/24); 1 case was Ablett Ⅱ, 1 was Ablett Ⅲ and 3 were Ablett Ⅳ. The number of the TCM group was 22 cases, with mortality of 22.7% (5/22), 2 cases were Ablett Ⅲ, 3 were Ablett Ⅳ. The TCM prescription of these 5 deceased cases was not directed towards tetanus. The tetanus TCM medication group was 15 cases, with no mortality. Case analyses: case 1 was intubated because of severe spasms. Autonomic dysfunction occurred on the 8th day after admission. Esmolol with increasing the dosage of the sedatives and muscle relaxant, was not effective. Tetanus TCM was applied after 2 days of autonomic dysfunction happened. Autonomic dysfunction was then under controlled on the 2nd day post-TCM. She was recovery and discharged after 4 weeks. Case 2, also was intubated because of severe spasms. Autonomic dysfunction happened on the 3rd day after admission, and failed to be controlled by large-dose sedatives, muscle relaxant, and Esmolol. After 8 days of persistent autonomic dysfunction, tetanus TCM was applied and autonomic dysfunction was under controlled on the 2nd day post-TCM administration. Large dosage of muscle-relaxant was applied continuously. After 5 days' administration of TCM, the TCM was withdrew. One day after the withdrawal of TCM, respiratory and cardiac arrest happened because of the diffused bronchiole obstruction with pulmonary secretions loading.Conclusion:Based on the precise and real-time diagnosis of the state of the disease, integrative medicine therapy with an overall analysis tetanus TCM prescription, is the key of declining tetanus mortality.
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OBJECTIVE：To explore the role of clinical pharmacists in the diagnosis and tre atment of immune checkpoint inhibitor related adrenocortical insufficiency ，so as to provide reference for the diagnosis and treatment of similar cases. METHODS：A lung squamous carcinoma patient with tumor immunotherapy ，who received long-term intravenous infusion of Pembrolizumab injection ，was hospitalized for more than 10 days due to fatigue and poor appetite. The clinical pharmacists consulted the literature and evaluated the correlation of ADR on the basis of patient ’s physical examination results （plasma cortisol 16.41 nmol/L at 8：00 in the morning on the second day of admission ，adrenocorticotropic hormone 8.39 pg/mL，serum electrolyte sodium 126.00 mmol/L，chlorine 88.00 mmol/L，etc.）and medication history （receiving the treatment with immune checkpoint inhibitors）. The clinical pharmacists assisted the doctor to confirm that the patient was adrenocortical insufficiency ，and the correlation with pembrolizumab was “very likely ”. On the basis of discontinuation of pembrolizumab ，it was recommended to take Hydrocortisone tablets orally （20 mg at 8：00 in the morning and 10 mg at 4：00 in the afternoon ）for glucocorticoid physiological dose substitution therapy. Before treatment ，the patient and his families should be educated on the use of drugs ，pharmaceutical care should be implemented to evaluate the glucocorticoid doseand efficacy during treatment ，and medication education was carried out at discharge. RESULTS ：The doctor adopted theli_xyan suggestions of the clinical pharmacist. On the 5th day after @126.com administration，the symptoms of adrenocortical insufficiency were significantly impro ved，and the patient was discharged with medicine. CONCLUSIONS ：During the treatment of the patient ， the clinical pharmacist gave full play to his pharmaceutical expertise ，assisted the doctor to formulate an appropriate medication plan，and carried out medication education for the patient and his family members ，so as to ensure the effectiveness and safety of the patient ’s medication. It is suggested that the baseline examination of patients should be improved before immune checkpoint inhibitor treatment ，including physical examination and plasma cortisol level at 8：00 in the morning ；the frequency of monitoring plasma cortisol level and serum electrolyte level at 8：00 in the morning. should be increased during medication ；the patients should be followed up for at least 1 year after withdrawal ，so as to early detect and treat immune checkpoint inhibitor related adrenocortical dysfunction.
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Objective:To evaluate the efficacy of roxatidine and omeprazolein on preventing gastrointestinal bleeding in critically ill patients.Methods:A prospective cohort study was conducted in adult patients admitted to an intensive care unit (ICU), who had risk factors for stress related mucosal disease (SRMD), and had an estimated stay of no less than 5 days and mechanical ventilation for more than 48 h. Patients were randomized into the experiment group (Roxatidine 75 mg IV Q12 h) and control group (Omeprazole 40 mg IV Q12 h). Demographic data, acute physiology and chronic health score (APACHEⅡ) and SOFA score on day 1 were collected, intragastric pH values were tested every 2 hours for the first 5 days, the daily average of pH and proportion of patients with average pH≥4 were calculated. Stool occult blood were detected at day 1 and bacterial culture of gastric juice were performed before medication administration and on day 5 after medication administration. The implementation of enteral nutrition support, situation of gastrointestinal hemorrhage and adverse effects were analyzed. Furthermore, length of hospital stay and mortality in ICU and on the 28th day were acquired. SPSS 22.0 software was used for data analysis. Consecutive data were expressed as mean and standard deviation, categorical data were expressed as frequencies (percentage). Comparison of measurement data between groups was performed by analysis of variance or rank sum test. Comparison of count data between groups was performed by the Chi-square test. P<0.05 was regarded as statistically significant. Results:A total of 91 patients were recruited and randomly separated into experimental group ( n=46) and control group ( n=45) from October 2017 to March 2018. There were no statistical differences in gender, age, body mass index (BMI), enteral nutrition status, APACHEⅡ and SOFA score on day 1 between the two groups (all P>0.05). Roxatidine in the experiment group rapidly increased the intragastric pH to ≥4.0 and continued to stabilize at pH ≥4.0 during the monitoring period. Omeprazole increased and maintained intragastric pH≥5.0. The proportion of patients with average pH≥4.0 was 82.5% in the second 24 hours in the experiment group, and stably increased to 90% on day 5. There were no significant differences between groups in gastrointestinal bleeding, length of hospital stay, and mortality in ICU and on 28th day(all P> 0.05). No drug related adverse effects occurred during the study period. Logistic-regression analysis did not screen for risk factors of SRMD. Conclusions:Roxatidine acetate hydrochloride can rapidly elevate and maintain the gastric pH above 4.0, and has similar efficacy and safety as omeprazole in inhibiting gastric acid secretion and preventing SRMD with gastrointestinal bleeding.
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Objective:Assessing the prognosis of patients with bladder urothelial carcinoma by using multiple molecular markers [epithelial-cadherin (E-cadherin), fibroblast growth factor receptor 3 (FGFR3), Jagged2, Survivin and stromal antigen 2 (STAG2)] in combination method, and compared it with the traditional method of evaluating prognosis by clinical pathological parameters.Methods:Retrospective analysis of 128 cases of bladder urothelial carcinoma patients admitted to Beijing Friendship Hospital, Capital Medical University from January 2010 to December 2016, including 102 males and 26 females; the median age was 70.5 years, ranged from 41 to 93 years. E-cadherin, FGFR3, Jagged2, Survivin and STAG2 alterations by immunohistochemistry during the first surgical treatment. The Kaplan-Meier survival curve was used to evaluate the relationship between the above markers and overall survival (OS), recurrence-free survival (RFS), progression-free survival (PFS), and clinicopathological indicators of tumors. Use Cox regression model to find the most suitable molecular markers for judging the prognosis of bladder urothelial carcinoma, and compare it with the traditional clinical staging + pathological grading method to evaluate OS to detect its sensitivity and specificity.Results:After 36.4 months of follow-up, it was found that the expressions of E-cadherin, FGFR3, Jagged2 and Survivin were all related to the OS, RFS and PFS of bladder urothelial carcinoma (all P<0.05). The expression of STAG2 was related to the TMN stage of bladder urothelial carcinoma ( P=0.047) and pathological grade ( P=0.015). Cox regression analysis showed that Survivin ( P=0.001) and Jagged2 ( P=0.037) were independent risk factors for evaluating the OS of bladder urothelial carcinoma, and Survivin ( P<0.001) and Jagged2 ( P=0.006) were independent risk factors for RFS, Survivin ( P=0.001) was also an independent risk factor for PFS. Multivariate analysis of the above molecular markers showed that the prognosis of patients with more than 3 molecular markers was better than that of independent application or the use of two of them to evaluate the prognosis ( P<0.001). The combined application of Survivin and Jagged2 to evaluate the 5-year survival rate was not less sensitive and specific than the clinical and pathological indicators (93.5% vs 77.2%, 84.7% vs 81.3%). Conclusions:Five molecular markers of E-cadherin, FGFR3, Jagged2, Survivin and STAG2 have an evaluation effect on the prognosis of bladder urothelial carcinoma, and some can independently predict the OS and RFS of patients with bladder urothelial carcinoma, however, the combined application is better than the single molecular marker to evaluate the prognosis. Compared with the traditional method of evaluating the prognosis by clinical pathological parameters, the combined application of Jagged2 and Survivin may be a better choice for evaluating the prognosis of patients with bladder urothelial carcinoma.
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Objective::To establish an LC-MS/MS method for the determination of alcohol-soluble components and water-soluble components in Arnebiae Radix(L-shikonin, β, β′-dimethylacrylshikonin, β-acetoxy-isovalerylshikonin, lithospermic acid, caffeic acid, rosmarinic acid), for the purpose of quality control of the herb. Method::Chromatographic separation was carried out at 35 ℃ on Agilent ZORBAX SB C18 (4.6 mm×50 mm, 1.8 μm), with 0.1% formic acid acetonitrile (A)-0.1% formic acid solution (B) as the mobile phase for gradient elution (0-3 min, 5%-95%A; 3-7 min, 95%A; 7-7.01 min, 95%-5%A; 7.01-8.5 min, 5%A). The flow rate was 0.2 mL·min-1, and the injection volume was 5 μL. In a negative ionization mode, MRM scanning mode was adopted for quantification. Result::The calibration curves of L-shikonin, β, β′-dimethylacrylshikonin, β-acetoxy-isovalerylshikonin, lithospermic acid, caffeic acid, rosmarinic acid showed a good linearity, and the linear ranges of the above six compounds were 10.12-1 012 μg·L-1(r=0.998 1), 10.88-1 088 μg·L-1(r=0.991 2), 10.08-806.4 μg·L-1(r=0.997 6), 20.32-1 016 μg·L-1(r=0.996 6), 10.37-1 037 μg·L-1(r=0.999 6), 10.26-1 026 μg·L-1(r=0.997 8), respectively. The average recoveries of the analysts were 95.8%(RSD 3.2%), 103.5%(RSD 2.3%), 105.3%(RSD 2.1%), 96.1%(RSD 3.3%), 98.9%(RSD 2.7%), 100.8%(RSD 3.4%). The contents of six components in 13 batches of samples showed significant differences. Conclusion::The established method is feasible and simple, and provides a basis for comprehensive quality evaluation of Arnebiae Radix.
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Objective:To discuss the clinical features of lymphoma of the male urogentioal system.Methods:The clinical data of 9 patients in Beijing Friendship Hospital from August 2014 to August 2019 reviewed, including 5 males and 4 females. The mean age of those patients was 62 years, range from 50 to 69.3 cases were diagnosed as renal tumor, 2 cases were diagnosed as bladder tumor and 4 cases were testicular tumor. 2 cases of the renal tumor presented with fever primarily(1 case with abdominal pain and weight loss) , 1 case was found renal pelvis tumor in medical checkup. 1 case of bladder lesions suffered from gross hematuria with abdominal pain and the other case with urinary frequency and urgency. All of the 4 testicular tumor cases were admitted to hospital with painless testicle mass. 5 cases were examined by CT showed low density mass with mild to moderate enhanced. Testicular tumors were detected by ultrasound showed irregular and heterogeneous mass with blood flow signals in them. 4 cases received operation and chemotherapy, 2 cases only received chemotherapy, 2 cases only received operation and 1 case didn’t receive further treatment. 1 case of 3 renal tumor cases received ultrasound-guided tumor biopsy and accepted rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone(R-CHOP) chemotherapy. 1 renal pelvis tumor patient received laparoscopic nephroureterectomy and R-CHOP chemotherapy. 1 case received ultrasound-guided tumor biopsy and refused further treatment. Both of two bladder tumor patients accepted TURBT and refused radiotherapy and chemotherapy. For 4 testicular tumor cases, 3 patients received orchiectomy and 1 patient received ultrasound-guided tumor biopsy. 3 cases accepted R-CHOP chemotherapy, 1 case received chemotherapy and contralateral testis irradiation(specific proposals unknown). All of 4 cases received CNS prophylaxis by intrathecal injection(methotrexate 15mg, cytarabine 50 mg and dexamethasone 5 mg).Results:All 9 cases who received surgery or biopsy recovered favorably, no complications were found. The histological type of them were non-Hodgkin lymphomas. 8 of 9 cases were diffuse large B-cell lymphomas, 1 case was anaplastic large cell lymphoma. Belonged to Ann Arbor staging system, 4 cases staged Ⅰ-ⅡE and 5 cases staged ⅢE-ⅣE. 6 cases had international prognostic index(IPI) scores 0-2, 2 cases ≥3. The average follow-up time was 18 months (6-66 months). 7 cases still alive, 3 of them completed chemotherapy, 2 cases achieved complete remission(1 case was testicular lymphoma stage ⅡE IPI score 1 point and 1 case was testicular lymphoma stage ⅣE IPI score 2 points), 1 case achieved partial remission(renal pelvis lymphoma stage ⅣE IPI score 3 points). 3 cases which refused chemotherapy didn’t relapse or progress(2 cases were bladder lymphomas stage ⅠIE IPI score 1 point and 1 case was renal pelvis lymphoma stage ⅠIE IPI score 1 point). 1 case developed bacterial combine fungal pneumonia after 2 chemotherapy periods and stopped chemotherapy. 1 case of renal lymphoma( stage ⅢE IPI score 3 points) and 1 case of testicular lymphoma( stage ⅢE IPI score 2 point) died of the tumor progression of 6 months and 17 months after diagnoses.Conclusions:The main histological type of the male urogentioal system lymphoma is diffuse large B-cell lymphoma which clinical feature of it is nonspecific. Differential diagnosis should be done with other genitourinary system tumor according to clinical symptom and imaging findings. Histological diagnosis is the gold standard and R-CHOP chemotherapy is recommended as the primary treatment.
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Objective: To explore the underlying mechanisms of drug-resistance of non-muscle invasive bladder cancer (NMIBC) to the intravesical chemotherapy. Methods: The chemoresistant bladder cancer cell line M-RT4 was established by continuous exposure of RT4 cells to mitomycin C (MMC). The chemoresistance and migration of M-RT4 cells were detected by CCK-8 assay and wound healing assay, respectively. The expressions of CXC chemokine ligand 5 (CXCL5) mRNA and protein in RT4 and M-RT4 cells as well as the recurrent NMIBC tissues were detected by real-time fluorescent quantitative PCR and Western blotting, respectively. The sensitivity of RT4 cells to MMC was observed after the treatment of recombinant human CXCL5 (rhCXCL5). The change of resistance of M-RT4 cells to MMC was detected by CCK-8 assay after siRNA transfection for CXCL 5 gene knockdown. The expressions of epithelial-mesenchymal transition (EMT)-associated factors [E-cadherin, cytokeratin-7 (Cyt-7), Claudin-1, N-cadherin, Vimentin and Snail] and nuclear factor-kappa B (NF-κB)-associated factors (NF-κB1, Rel A, NF-κB2 and Rel B) during the drug resistance of NMIBC cells were detected by Western blotting. Results: Compared to RT4 cells, the resistance of M-RT4 cells to MMC was significantly increased (P < 0.01), while the proliferation and migration of M-RT4 cells were enhanced (P < 0.05, P < 0.01). CXCL5 mRNA was over-expressed in the recurrent NMIBC tissues (P < 0.000 1), while the expression levels of CXCL5 mRNA and protein in M-RT4 cells were higher than those in RT4 cells (both P < 0.01). The sensitivity of RT4 cells to MMC was decreased after the treatment with rhCXCL5 (P < 0.01), whereas the sensitivity of M-RT4 cells to MMC was increased after CXCL 5 gene knockdown (P < 0.01). As compared with RT4 cells, the expressions of E-cadherin, Cyt-7 and Claudin-1 in M-RT4 cells were significantly decreased (all P < 0.01), but the expressions of N-cadherin, Vimentin, NF-κB1, Rel A, NF- κB2 and Rel B were increased (all P < 0.05). The treatment of rhCXCL up-regulated the expressions of Snail, NF-κB1, Rel A and Rel B in RT4 cells (all P < 0.05). Knockdown of CXCL 5 gene inhibited Snail activation (P < 0.05), up-regulated Cyt-7 expression (P < 0.01), and down-regulated the expressions of NF-κB1, Rel A and Rel B in M-RT4 cells (all P < 0.05). Conclusion: CXCL5 is over-expressed in NMIBC tissues and the chemoresistant bladder cancer cells. Knockdown of CXCL 5 gene expression may reduce the resistance of M-RT4 cells to MMC by reversing EMT, suggesting that CXCL5 is an important factor leading to the intravesical chemoresistance of NMIBC.
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The treatment of acute necrotizing fasciitis consists of early and aggressive incision and drainage, together with effective antibiotics and active organ support. On January 4th, 2018, a 50-year-old man admitted to intensive care unit (ICU) of Peking University Third Hospital was diagnosed with acute necrotizing fasciitis in the right lower extremity caused by group A Streptococcal infection complicated with multiple organ dysfunction. The disease progressed rapidly. The lesion rapidly spread from the right calf to the entire right lower limb and was associated with septic shock and multiple organ dysfunction within a few hours after admission. The treatment included surgical debridement and amputation of his right lower extremity, multiple antimicrobials combination therapy, gamma globulin-assisted anti-infection, anti-shock, bedside continuous hemofiltration and other comprehensive treatment. The patient was successfully cured. The key to successful treatment of this patient is that when the acute necrotizing fasciitis progresses rapidly, amputation should be done to debride the infected lesions, together with early empirical broad-spectrum antibiotics combination therapy and active organ function support treatment.
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The treatment of acute necrotizing fasciitis consists of early and aggressive incision and drainage, together with effective antibiotics and active organ support. On January 4th, 2018, a 50-year-old man admitted to intensive care unit (ICU) of Peking University Third Hospital was diagnosed with acute necrotizing fasciitis in the right lower extremity caused by group A Streptococcal infection complicated with multiple organ dysfunction. The disease progressed rapidly. The lesion rapidly spread from the right calf to the entire right lower limb and was associated with septic shock and multiple organ dysfunction within a few hours after admission. The treatment included surgical debridement and amputation of his right lower extremity, multiple antimicrobials combination therapy, gamma globulin-assisted anti-infection, anti-shock, bedside continuous hemofiltration and other comprehensive treatment. The patient was successfully cured. The key to successful treatment of this patient is that when the acute necrotizing fasciitis progresses rapidly, amputation should be done to debride the infected lesions, together with early empirical broad-spectrum antibiotics combination therapy and active organ function support treatment.
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OBJECTIVE: To investigate the role of vaginal microbial metabolites and enzyme changes and high-risk human papillomavirus(HR-HPV)infection in cervical intraepithelial neoplasia(CIN)and their interaction effects.METHODS: From June 2014 to December 2014,demographic characteristics and CIN-related factors and cervical liquid-based cytology(TCT)examination results were collected from 40 000 community-based populations from two regions of Shanxi Province by the Second Hospital of Shanxi Medical University.Patients who meet the criteria for enrollment were further tested for vaginal microecology,HPV testing,and colposcopic and pathologic examination.A total of 782 cases with pathological diagnosis of CIN were chosen as the case group;1503 patients with normal pathological results were chosen as a control group.A multivariate logistic regression model was established to analyze the vaginal microbial metabolic enzymes cross-sectionally,then the association between vaginal microbial metabolic changes and CIN risk was evaluated.RESULTS: The expression of hydrogen peroxide(H2 O2),β-glucuronidase(GUS)and sialidase(SNA)was statistically correlated with CIN risk,and the odd ratios were 1.60(95% CI 1.30-1.96),1.58(95% CI 1.30-1.92),and 1.45(95% CI1.18-1.79),respectively.The expression of acetylglucosaminidase(NAG)and leukocyte esterase(LE)had no statistical association with CIN risk.Interaction analysis showed that there were positive multiplicative interactions among H2 O2,GUS,SNA and HR-HPV infections in the occurrence of CIN.CONCLUSION: Positive H2 O2,GUS,and SNA is associated with increased risk of CIN,and they have positive interaction with HR-HPV infection,which increases the risk of CIN.
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Hyperandrogenism is one of the major clinical characteristics of PCOS,which can be assessed either by biochemical determination of hyperan⁃drogenism or clinical manifestations of hyperan⁃drogenism to make diagnosis.Hyperandrogenism leads to ovulatory dysfunction and menstrual disorder by affecting follicular development,and causes hirsutism and acne as well;it is closely associated with the de⁃velopment of endometrial cancers,diabetes and car⁃diovascular diseases from the long-term perspective.Therefore,it is imperative to fully understand charac⁃teristics and management of PCOS-related hyperan⁃drogenism,which is an important part of the compre⁃hensive therapy for PCOS.
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Objective@#To investigate the value of routine indexes of blood, biochemistry and coagulation in assessing microcirculation in children with sepsis, and explore the related mechanism.@*Methods@#The clinical data of 187 children with sepsis from July 2013 to July 2018 in Wuxi Children′s Hospital of Jiangsu Province were retrospectively analyzed. The lactic acid, D- dimmer (DD), platelet distribution width (PDW), red blood cell volume distribution width (RDW), albumin, capillary refill time (CRT), simplify pediatric clinical illness score (PCIS) and prognosis were observed. The children were divided into 3 groups according to the simplify PCIS: non-severe group (simplify PCIS>80 scores, 96 cases), severe group (simplify PCIS 71 to 80 scores, 64 cases), and extremely severe group (simplify PCIS ≤ 70 scores, 27 cases); the children were divided into 2 groups according to the prognosis: survival group (161 cases) and death group (26 cases); the children were divided into 3 groups according to the CRT: capillary refilling better group (CRT<1.0 s, 99 cases), capillary refilling infaust group (CRT 1.0 to 2.9 s, 60 cases), capillary refilling bad group (CRT ≥ 3.0 s, 28 cases).@*Results@#The lactic acid, DD, PDW, RDW and fatality rate in non-severe group, severe group and extremely severe group were gradually increased: (2.281 ± 1.103), (4.839 ± 2.154), (7.019±3.014) mmol/L; (2.103 ± 0.133), (3.632 ± 0.218), (5.179 ± 0.113) mg/L; 0.122 ± 0.010, 0.149 ± 0.011, 0.177 ± 0.016; 0.137 ± 0.012, 0.151 ± 0.018, 0.169 ± 0.021; 2.08% (2/96), 14.06% (9/64), 55.56% (15/27), while the albumin was gradually decreased: (34.21 ± 13.72), (30.38 ± 18.63), (22.37 ± 16.31) g/L, and there were statistical differences (P<0.01). The lactic acid, DD, PDW and RDW in survival group were significantly lower than those in death group: (3.127 ± 1.312) mmol/L vs. (6.837 ± 2.174) mmol/L, (2.473 ± 1.713) mg/L vs. (4.213 ± 1.101) mg/L, 0.124 ± 0.012 vs. 0.170 ± 0.023 and 0.148 ± 0.022 vs. 0.171 ± 0.017, while the albumin was significantly higher than that in death group: (33.59 ± 16.90) g/L vs. (19.92 ± 18.70) g/L, and there were statistical differences (P<0.01 or <0.05). The lactic acid, DD, PDW and RDW in capillary refilling better group, capillary refilling infaust group and capillary refilling bad group were gradually increased: (2.362 ± 2.131), (5.312 ± 1.114), (8.121 ± 2.213) mmol/L; (2.072 ± 0.213), (3.923 ± 0.178), (5.317 ± 0.517) mg/L; 0.119 ± 0.021, 0.153 ± 0.012, 0.171 ± 0.011; 0.127 ± 0.021, 0.148 ± 0.015, 0.168 ± 0.027; while the albumin was gradually decreased: (35.37 ± 14.11), (31.21 ± 15.13), (22.87 ± 15.22) g/L, and there were statistical differences (P<0.01).@*Conclusions@#The lactic acid, DD, PDW, RDW, ALB and CRT have some value in assessing microcirculation in children with sepsis, and the change of component and construction in microcirculation is the cause of developing of these indexes.
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Objective To investigate the value of routine indexes of blood, biochemistry and coagulation in assessing microcirculation in children with sepsis, and explore the related mechanism. Methods The clinical data of 187 children with sepsis from July 2013 to July 2018 in Wuxi Children′s Hospital of Jiangsu Province were retrospectively analyzed. The lactic acid, D- dimmer (DD), platelet distribution width (PDW), red blood cell volume distribution width (RDW), albumin, capillary refill time (CRT), simplify pediatric clinical illness score (PCIS) and prognosis were observed. The children were divided into 3 groups according to the simplify PCIS: non-severe group (simplify PCIS＞80 scores, 96 cases), severe group (simplify PCIS 71 to 80 scores, 64 cases), and extremely severe group (simplify PCIS≤70 scores, 27 cases); the children were divided into 2 groups according to the prognosis: survival group (161 cases) and death group (26 cases); the children were divided into 3 groups according to the CRT: capillary refilling better group (CRT﹤1.0 s, 99 cases), capillary refilling infaust group (CRT 1.0 to 2.9 s, 60 cases), capillary refilling bad group (CRT ≥ 3.0 s, 28 cases). Results The lactic acid, DD, PDW, RDW and fatality rate in non-severe group, severe group and extremely severe group were gradually increased: (2.281 ± 1.103), (4.839 ± 2.154), (7.019 ± 3.014) mmol/L; (2.103 ± 0.133), (3.632 ± 0.218), (5.179 ± 0.113) mg/L; 0.122 ± 0.010, 0.149 ± 0.011, 0.177 ± 0.016; 0.137 ± 0.012, 0.151 ± 0.018, 0.169 ± 0.021; 2.08% (2/96), 14.06% (9/64), 55.56% (15/27), while the albumin was gradually decreased: (34.21 ± 13.72), (30.38 ± 18.63), (22.37 ± 16.31) g/L, and there were statistical differences (P﹤0.01). The lactic acid, DD, PDW and RDW in survival group were significantly lower than those in death group: (3.127 ± 1.312) mmol/L vs. (6.837 ± 2.174) mmol/L, (2.473 ± 1.713) mg/L vs. (4.213 ± 1.101) mg/L, 0.124 ± 0.012 vs. 0.170 ± 0.023 and 0.148 ± 0.022 vs. 0.171 ± 0.017, while the albumin was significantly higher than that in death group: (33.59 ± 16.90) g/L vs. (19.92 ± 18.70) g/L, and there were statistical differences (P﹤0.01 or﹤0.05). The lactic acid, DD, PDW and RDW in capillary refilling better group, capillary refilling infaust group and capillary refilling bad group were gradually increased: (2.362 ± 2.131), (5.312 ± 1.114), (8.121 ± 2.213) mmol/L; (2.072 ± 0.213), (3.923 ± 0.178), (5.317 ± 0.517) mg/L; 0.119 ± 0.021, 0.153 ± 0.012, 0.171 ± 0.011; 0.127 ± 0.021, 0.148 ± 0.015, 0.168 ± 0.027; while the albumin was gradually decreased: (35.37 ± 14.11), (31.21 ± 15.13), (22.87 ± 15.22) g/L, and there were statistical differences (P﹤0.01). Conclusions The lactic acid, DD, PDW, RDW, ALB and CRT have some value in assessing microcirculation in children with sepsis, and the change of component and construction in microcirculation is the cause of developing of these indexes.