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Objective:To analyze the clinical characteristics and prognosis of coronavirus disease 2019 (COVID-19) patients complicated with pneumothorax.Methods:The clinical data of 7 COVID-19 patients complicated with pneumothorax admitted to Huanggang Central Hospital from January 3 to March 10, 2020 were retrospectively analyzed. The clinical features, diagnosis and treatment were summarized, and experience in the treatment of COVID-19 was shared.Results:① General information: among the 7 patients, 5 were males and 2 were females. Four of them had no underlying disease, and 1 had a history of diabetes and hypertension. One patient had only a history of hypertension. There were 6 cases of right pneumothorax and 1 case of bilateral pneumothorax. The 7 patients had a long hospital stay, all over 4 weeks, mostly complicated with multiple organ dysfunction. ② Imaging examination: 1 case evolved from the early stage to the advanced stage within 1 week and to the severe stage within 2 weeks. Pneumothorax occurred 4 weeks later, and was absorbed within 2 weeks. The remaining 6 patients presented progressive stage on admission, all of them advanced to severe stage within 1 to 2 weeks, and most of them presented diffused consolidation shadows, striation shadows and fibrosis of both lungs, obvious pleural adhesion, and extremely slow lesion absorption. ③ Treatment: 1 severe patient with pneumothorax 4 weeks after onset was given non-invasive mechanical ventilation. The remaining 6 critically ill patients were treated with endotracheal intubation and mechanical ventilation. Five patients were treated with mechanical ventilation within 3 days after the occurrence of pneumothorax, and 1 patient was treated with mechanical ventilation after 11 days. ④ Outcome: 1 patient without endotracheal intubation was continuously given nasal high-flow oxygen therapy, and the condition was stable. Four of the 6 patients complicated with pneumothorax after endotracheal intubation died, and the other 2 patients successfully removed the drainage tube within 2 weeks of closed thoracic drainage, and their condition gradually stabilized.Conclusion:COVID-19 complicated with pneumothorax is a dangerous disease with poor prognosis, and should be paid adequate attention.
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Inflammatory bowel disease (IBD) is a chronic nonspecific intestinal inflammatory disease, studies both at home and abroad have shown that the incidence of Clostridium difficile infection (CDI) in IBD patients is increasing yearly, and the rates of colectomy and mortality are high, which cause significant healthcare and economic burden. This article reviewed the research progress on risk factors related to IBD complicated with CDI, so as to be helpful for the early detection and prevention of CDI.
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Purpose@#Numerous studies have shown that the frequency of myeloid-derived suppressor cells (MDSCs) is associated with tumor progression, metastasis, and recurrence. Chemokine (C-C motif) ligand 3 (CCL3) may be secreted by tumor cells and attract MDSCs into the tumor microenvironment. In the present study, we aimed to explore the molecular mechanisms whereby CCL3 is involved in the interaction of breast cancer cells and MDSCs. @*Methods@#The expression of CCL3 and its receptors was investigated using real-time polymerase chain reaction, western blotting, and enzyme-linked immunosorbent assay. The cell counting Kit-8, wound healing, and transwell assays were performed to study cell growth, migration, and invasion. Cell cycling, apoptosis, and the frequency of MDSCs were investigated through flow cytometry. Transwell assays were used for co-culture and chemotaxis detection. Markers of the epithelial-mesenchymal transition (EMT) were determined with western blotting. The role of CCL3 in vivo was studied via tumor xenograft experiments. @*Results@#CCL3 promoted cell proliferation, migration, invasion, and cycling, and inhibited apoptosis of breast cancer cells in vitro. Blocking CCL3 in vivo inhibited tumor growth and metastases. The frequency of MDSCs in patients with breast cancer was higher than that in healthy donors. Additionally, MDSCs might be recruited by CCL3. Co-culture with MDSCs activated the phosphoinositide 3-kinase-protein kinase B-mammalian target of rapamycin (PI3K-Akt-mTOR) pathway and promoted the EMT in breast cancer cells, and their proliferation, migration, and invasion significantly increased. These changes were not observed when breast cancer cells with CCL3 knockdown were co-cultured with MDSCs. @*Conclusion@#CCL3 promoted the growth of breast cancer cells, and MDSCs recruited by CCL3 interacted with these cells and then activated the PI3K-Akt-mTOR pathway, which led to EMT and promoted the migration and invasion of the cells.
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OBJECTIVE@#To explore whether thrombopoietin (TPO) can rescue megakaryopoiesis by protecting bone marrowderived endothelial progenitor cells (BM-EPCs) in patients receiving chemotherapy for hematological malignancies.@*METHODS@#Bone marrow samples were collected from 23 patients with hematological malignancies 30 days after chemotherapy and from 10 healthy volunteers. BM-EPCs isolated from the samples were identified by staining for CD34, CD309 and CD133, and their proliferation in response to treatment with TPO was assessed using CCK8 assay. DiL-Ac-LDL uptake and FITC-UEA-I binding assay were performed to evaluate the amount of BM-EPCs from the subjects. Tube-formation and migration experiments were used for functional assessment of the BM-EPCs. The BM-EPCs with or without TPO treatment were co-cultured with human megakaryocytes, and the proliferation of the megakaryocytes was detected with flow cytometry.@*RESULTS@#Flow cytometry indicated that the TPO-treated cells had high expressions of CD34, CD133, and CD309. CCK8 assay demonstrated that TPO treatment enhanced the proliferation of the BM-EPCs, and the optimal concentration of TPO was 100 μg/L. Double immunofluorescence assay indicated that the number of BM-EPC was significantly higher in TPO-treated group than in the control group. The TPO-treated BM-EPCs exhibited stronger tube-formation and migration abilities ( < 0.05) and more significantly enhanced the proliferation of co-cultured human megakaryocytes than the control cells ( < 0.05).@*CONCLUSIONS@#TPO can directly stimulate megakaryopoiesis and reduce hemorrhage via protecting the function of BM-EPCs in patients following chemotherapy for hematological malignancies.
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Humans , Bone Marrow , Bone Marrow Cells , Cells, Cultured , Hematologic Neoplasms , Megakaryocytes , ThrombopoietinABSTRACT
Objective To investigate the diagnostic effect of diffusion tensor imaging (DTI) on spinal neurotype brucellosis spondylitis (BS).The characteristics of apparent diffusion coefficient (ADC) value and fractional anisotropy (FA) value of spinal neurotype BS in different disease stages were quantitatively analyzed to evaluate the different forms of spinal neurofibrillary tract injury.Methods A prospective design was used to collect data of BS patients with spinal neurological symptoms from June 2015 to July 2017 in the First Affiliated Hospital of Hebei North University as the brucellosis group (n =39),including 23 males and 16 females,aged (20.8 ± 15.3) years old.Healthy subjects were selected as the control group (n =30),including 20 males and 10 females,aged (25.2 ± 4.0) years old.The brucellosis group was divided into acute stage (＜ 3 months),subacute stage (3-6 months) and chronic stage (＞ 6 months),with 12,10 and 17 cases,respectively.Routine spinal scans and DTI scans were performed using a 3.0T superconducting magnetic resonance imaging (MRI) scanner,DTI used Fiber Trak package to measure ADC value and FA value and perform quantitative analysis [receiver operating characteristic (ROC) curve],and reconstructed the changed form of the spinal neurotype BS nerve fiber bundle.Results A total of 39 patients' data were collected in the brucellosis group.Among them,5 patients showed segmental thickening of spinal nerves on conventional MRI,high signal on T2 weighted imaging (T2WI) and short time inversion recovery (STIR),and color code changes on DTI scan FA imaging.Routine MRI of 34 patients showed spinal cord compression,spinal cord morphological changes or cauda equina nerve aggregation and displacement,while DTI scan FA imaging showed spinal cord or cauda equina nerve morphological changes,but no color code changes.The ADC values of patients in the acute and subacute stages were higher than that of the control group [(1.41 ± 0.05),(1.31 ± 0.05),(1.23 ± 0.05) × 10-3 mm2/s,P ＜ 0.05],and the FA values were lower than that of the control group (0.40 ± 0.04,0.68 ± 0.08,0.76 ± 0.05,P ＜ 0.05).There were no statistically significant differences in ADC and FA values between patients with chronic spinal neurotype BS [(1.25 ± 0.04) × 10-3 mm2/s,0.72 ± 0.04] and the control group (P ＞ 0.05).ROC curve analysis showed that the area under curve (AUC),specificity,sensitivity and accuracy of ADC were 0.912,0.942,0.930 and 0.924,respectively.The AUC,specificity,sensitivity and accuracy of FA were 0.901,0.937,0.928 and 0.943,respectively.The change forms of spinal neurotype BS were:① color code change;② loss/fracture;③ displacement and pressure;④ rarity.Conclusion DTI plays a diagnostic role in spinal neurotype BS,and can quantitatively analyze the characteristics of changes in ADC value and FA value in different periods,and can clearly display the forms of changes in spinal neurofiber,providing a reliable basis for the diagnosis of spinal neurotype BS.
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Objective To explore the value of OSCE system combined with intelligent network in-formation platform in clinical skills assessment of obstetrics and gynecology. Methods 112 clinical medi-cal students who participated in the practice of gynecology and obstetrics in Second Military Medical Uni-versity in 2017 were randomly divided into the experimental group (network information OSCE) and the control group (traditional OSCE). The teaching results were evaluated by the questionnaire survey of teachers and students and the examination results as well. The statistical analysis was made with the Chi-square test and the t test respectively. Results According to the questionnaire survey of two skills assessment methods, the satisfaction index of the experimental group was higher than that of the control group in both teachers and students, and the difference was statistically significant (P<0.05). The total time of examination in the experimental group was lower than that of the control group, and the difference was statistically significant (P<0.05). The final total score and the results of case analysis and clinical operation examination of experi-mental group were all higher than those of the control group, but there was no statistical difference (P>0.05). Conclusion OSCE combined with the network information system has an unparalleled advantage in the assessment of the obstetrics and gynecology department. The system will promote clinical education of ob-stetrics and gynecology and the evaluation of the clinical ability of the medical students to a new height, which deserves popularization.
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Objective@#To investigate the levels of NK cells and their relevant cytokines (IL-10, TGF-β and IFN-γ) in patients with primary immune thrombocytopenia (ITP) .@*Methods@#All samples were obtained from 42 patients (22 newly diagnosed and 20 in remission) and 20 healthy volunteers. The levels of IL-10 and IFN-γ in blood serum were detected by enzyme-linked immunosorbent assay (ELISA) . The percentage of CD3- CD56+ NK cell, CD3- CD56bright CD16- NK cell, CD3- CD56dim CD16+ NK cell in peripheral blood lymphocyte were detected by flow cytometry. The NK cells were isolated by immunomagnetic microbeads. The mRNA expression levels of IL-10, TGF-β, and IFN-γ in NK cells were detected by real-time fluorescent quantitative PCR. Correlation between the above measured results was analyzed.@*Results@#① The blood serum level of IFN-γ in newly diagnosed ITP patients [ (653.0±221.6) ng/L] was higher than that in remission ITP patients [ (484.4±219.5) ng/L] and healthy control [ (390.9±253.5) ng/L] (P=0.022, P=0.001) . The blood serum level of IL-10 in newly diagnosed ITP patients was lower than that in healthy control [ (52.09±26.66) ng/L vs (79.44±38.43) ng/L, P=0.007]. ②The percentage of NK cell in newly diagnosed and remission ITP patients [ (9.53±3.93) %, (9.03±3.78) %] were significantly lower than that in healthy control [ (13.72±7.42) %] (P=0.013, P=0.007) . The ratio of CD3- CD56bright CD16- NK cell/total NK cells in newly diagnosed ITP patients was higher than that in healthy control [ (6.85±4.43) % vs (4.05±2.81) %, P=0.032]. The ratio of CD3-CD56dim CD16- NK cell/total NK cells in newly diagnosed ITP patients was lower than that in healthy control [ (93.14±4.43) % vs (95.94±2.81) %, P=0.032]. ③ There was no significant difference in the mRNA expression level of IFN-γ in NK cells of ITP patients and healthy control (all P>0.05) . The mRNA expression levels of IL-10 and TGF-β in NK cells in newly diagnosed ITP patients were significantly higher than that in healthy control (1.82±1.32 vs 1.02±1.03, P=0.023; 2.80±2.31 vs 1.46±1.37, P=0.028) . The ratio of CD3-CD56bright CD16- NK cell/total NK cells was positively correlated with the mRNA expression levels of IL-10, TGF-β in NK cells (r=0.424, P=0.001; r=0.432, P<0.001) .@*Conclusion@#NK cells may compensate for the deficiency of the number by enhancing the secretion of negative regulation cytokines, acting as "protective" roles in the disease.
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Objective:To investigate the effects and mechanisms of anti-cancer by bacailein combined with U0126 on human breast cancer in vitro. Methods: The human breast cancer cell line MCF-7 was treated by baicalein,U0126 and baicalein combined with U0126 respectively. CCK8 assay measured cell proliferation of MCF-7;flow cytometry tested the cell cycle and apoptosis of MCF-7;microscopy observed the amount;TUNEL assay evaluated the apoptosis of MCF-7;Western blot detected the protein level of proliferation and apoptosis related protein;scratch assay measured the ability of migration. Results: Human breast cancer cell line MCF-7 was treated by baicalein or U0126 at different concentration for 24 h, CCK8 assay suggested that both of them can dramatically inhibit MCF-7 proliferation in a dose-dependent way (P<0. 05). Compared to the blank and DMSO groups,the human breast cancer cell line MCF-7 was treated with baicalein for 24 h,the cellular rate at G0-G1 phase increased a lot (91%) (P<0. 05),while the cellular rate at S phase reduced dramatically (P<0. 05),cell apoptosis increased dramatically by microscopy and TUNEL assay(P<0. 05),the level of ERK1/2,CyclinD1 and JNK reduced quickly (P<0. 05). Compared to the baicalein group,MCF-7 was treated by baicalein combined with U0126,the cellular rate at S phase decreased remarkably (P<0. 05),apoptosis was much obvious (P<0. 05),the phosphorylation level of ERK1/2 and JNK reduced a lot (P<0. 05),and the proliferation accelerator CyclinD1 highly decreased (P<0. 05);the scratch assay demonstrated that cell migration was dramatically inhibited when MCF-7 was treated by 20 μmol/L baicalein ( P<0. 05 ) . Conclusion:Both of baicalein and U0126 can inhibit the proliferation and migration,induce the apoptosis of human breast cancer cell line MCF-7 through decreasing the level of ERK, JNK and CyclinD1. Baicalein and U0126 can provide some novel avenues to treat breast cancer in clinic.
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Objective To analyze the clinicopathological characteristics and prognosis of different subtypes of breast cancer patients with bone metastasis.Methods For this study, we recruited 300 primary breast cancer patients with bone metastasis treated at the Department of Oncology, the First Affiliated Hospital of Xi`an Jiaotong University, between September 1, 2007 and September 1, 2011.We also retrospectively analyzed their clinical and follow-up data.Results The percentage of Luminal A, Luminal B, human epidermal growth factor receptor-2 (HER-2) overexpression and triple negative subtypes in all the bone metastatic breast cancer patients was 59.0％, 16.0％, 13.7％ and 11.3％, respectively.Age, tumor size and histologic grade significantly differed among the four subtypes (P0.05).The median survival time of Luminal A breast cancer patients with bone metastasis was 28.6 months, longer than Luminal B (26.9 months), HER-2 overexpression (20.9 months) and triple negative breast cancer patients (12.0 months) with bone metastasis.The overall survival significantly differed among the patients with four subtypes of breast cancer.Conclusion Different subtypes of breast cancer patients with bone metastasis have different clinical characteristics and prognosis.Luminal A breast cancer patients with bone metastasis have better prognosis whereas triple negative subtype has poorer prognosis.
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Objective:To investigate the role of Baicalein combined with U0126 resisting human bladder cancer T-24 cells in vitro and mechanism.Methods: T-24 cells were dealt with Baicalein combined with U0126,flow cytometry was used to detect cell cycle and cell apoptosis,microscope to count cell number,TUNEL method to detects cell apoptosis index,and Real time quantitative PCR and Western blot to measure extracellular signal regulating kinase 1/2 (ERK1/2), CyclinD1, GSK-3β and AKT RNA level, protein level of T-24 cells respectively.Effect of Baicalein and U0126 on apoptosis and proliferation of bladder cancer cell was analyzed.Results: Cell apoptosis rate was significantly increased after T-24 cells dealt with various concentrations of Baicalein.Cell proportion of G0/G1 phase was significantly increased,while cell percentage of S phase was obviously decreased and cell count was decreased,after T-24 cells were dealt with Baicalein for 24 h.After T-24 cells were dealt with Baicalein combined with U0126 for 24 h,cell proportion of S phase was evidently decreased.T-24 cells were dealt with Baicalein or U0126 obviously promoted cell apoptosis,which was more obvious with Baicalein combined with U0126.Phosphorylation level of GSK-3β,ERK1/2,and AKT was significantly reduced and expression of ERK1/2 and CyclinD1 mRNA was evidently lower after Baicalein or U0126 or Baicalein combined with U0126,and combined application had more remarkable effect.Conclusion: Baicalein and U0126 can induce apoptosis of T-24 cells,increase cell proportion in G0/G1 phase,reduce cell proportion of S phase,and Baicalein combined with U0126 effect has more remarkable effect.
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To evaluate the efficacy and safety of neoadjuvant chemotherapy combined with bevacizumab versus neoadjuvant chemotherapy alone for Her2-negative breast cancer.We searched PubMed, the Cochrane Library, Web of Science, CNKI, Wanfang Database and the abstracts of major international conferences in recent 5 years to identify prospective randomized controlled clinical trials that met the inclusion and exclusion criteria. Study selection and analyses were undertaken according to the Cochrane Handbook. Meta-analysis was performed using RevMan 5.3 software.Six trials were identified with 4440 eligible patients. The results of this meta-analysis showed that the rate of pathological complete response (pCR) was higher in Her-2 negative breast cancer patients receiving bevacizumab combined with neoadjuvant chemotherapy than that in patients with neoadjuvant chemotherapy alone (24.7% vs 20.1%,=1.23, 95%:1.10-1.37,<0.01). In addition, the pCR rate rose up when bevacizumab was added to neoadjuvant chemotherapy both in hormone receptor-positive patients (13.1% vs 10.2%,=1.28, 95%:1.04-1.58,<0.05) and in hormone receptor-negative patients (46.3% vs 37.1%,=1.25, 95%:1.12-1.39,<0.01). Statistical differences were observed in the rate of relevant adverse events such as hypertention (3.2% vs 0.6%,=5.292, 95%:2.933-9.549,<0.01) and mucositis (10.5% vs 2.0%,=5.340, 95%:3.743-7.617,<0.01) between the combination group and the chemotherapy alone group. Differences in other toxicities such as febrile neutropenia, infection, surgical complications, neutropenia and hand-foot syndrome were also found to be statistically significant between the combination group and the chemotherapy alone group (all<0.05), while such difference was not found in the occurrence of peripheral neuropathy (>0.05).The addition of bevacizumab to neoadjuvant chemotherapy in Her2-negative breast cancer can significantly improve pathological complete response, but may bring more grade 3 and 4 toxicities.More neoadjuvant trials need to be done to define subgroups of Her2-negative breast cancer that would have clinically significant long-term benefit from bevacizumab treatment.
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Female , Humans , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Toxicity , Bevacizumab , Therapeutic Uses , Toxicity , Breast Neoplasms , Chemistry , Drug Therapy , Neoadjuvant Therapy , Methods , Prospective Studies , Receptor, ErbB-2 , Triple Negative Breast Neoplasms , Drug TherapyABSTRACT
Objective To investigate the predictive value of continuous dynamic monitoring of intrapulmonary shunt (Qs/Qt) in patients with acute respiratory distress syndrome (ARDS).Methods A prospective observational study was conducted.The adult patients with ARDS undergoing mechanical ventilation admitted to intensive care unit (ICU) of Tianjin Third Central Hospital from June 2014 to December 2015 were enrolled.Baseline characteristics,demographic data and relevant physiologic data were recorded.All patients were divided into survivors and non-survivors according to the outcome of patients within 28 days.Artery and mixed venous blood was collected immediately after admission for blood gas analysis,and daily Qs/Qt within 7 days was continuously monitored in ARDS patients.The receiver operating characteristic curve (ROC) was used to evaluate the prognosis accuracy of Qs/Qt.Results In 46 enrolled ARDS patients,20 died,and 26 survived.During the first 7 days of ARDS,the mean Qs/Qt in survivors showed an increasing tendency [(23 ± 6)％,(27 ± 6)％,(28 ± 9)％,respectively,at 1-3 days] and a downtrend tendency from 4 days [(27 ± 5)％,(25 ± 4)％,(19 ± 4)％,(16 ± 2)％,respectively,at 4-7 days].However,a rising tendency of Qs/Qt in non-survivors was found at 1-7 days [(28 ± 7)％,(30 ± 3)％,(33 ± 6)％,(33 ± 11)％,(34 ± 5)％,(33 ± 6)％,(35 ± 6)％,respectively],and Qs/Qt from the 5th day in non-survivors was significantly higher than that in survivors (all P ＜ 0.05).The fluctuation of oxygenation index (PaO2/FiO2) within 1 week in both groups was small,and PaO2/FiO2 (mmHg,1 mmHg =0.133 kPa) at 1-7 days in survivors was 167.37±43.98,180.55±39.90,174.27±35.47,188.64±39.74,252.54±49.22,239.35±25.63,248.93±45.64,respectively,and it was 168.65±35.54,182.31 ± 32.36,159.80 ± 34.39,176.97 ± 31.75,200.69 ± 45.33,185.98 ± 36.47,and 175.43 ± 30.98 in non-survivors respectively.PaO2/FiO2 was significantly lower in non-survivors than survivors from 5 days (all P ＜ 0.05).It was shown by ROC curve that area under ROC curve (AUC) for Qs/Qt evaluating the prognosis on the 5th day was 0.958,and 95％ confidence interval (95％CI) was 0.777-0.999 (P ＜ 0.000 1,Z =13.13).When the cut-off value of Qs/Qt was 28％,sensitivity and specificity were 83.3％ and 90.0％,respectively.AUC for PaO2/FiO2 evaluating the prognosis on the 5th day was 0.790,and 95％CI was 0.577-0.928 (P =0.002 1,Z =3.08).When the cut-off value of PaO2/FiO2 was 223 mmHg,sensitivity and specificity were 69.2％ and 81.8％,respectively.Conclusion Dynamic Qs/Qt surveillance can help physician to analyze the changes of the patient's condition,and it was better than PaO2/FiO2,and can be an important evaluation indicator of prognosis for ARDS patients.
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Objective To investigate the effect of interferon alfα-2b on the ultrastructure and Caspase-3 levels in villus in early pregnancy with bacterial vaginal disease (BV). Method Early pregnant women were divided into two groups. The treated group included 25 early pregnant women with BV who chose to have an early termination and were treated with rhINFα-2b. The controling group included 30 early pregnant women without any genital tract infectious diseases. The caspase-3 levels in trophocytes were detected by immunochemistry and the ultrastructural changes were observed in villus by transmission electron microscopy. Result (1)There was no apparent difference of ultrastructural changes between the two groups. (2)There was no statistical significance of the levels of caspase-3 between the two groups (P>0.05). Conclusion The excessive apoptosis do not occur in the trophocytes when treated with INFα-2b.
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Objective To investigate the expression change of LRP16 in endometrial cancer tissues and its influence on the pro-liferation of human endometrial carcinoma HEC-1-B cells .Methods HEC-1-B cells were transfected with LRP16 .RT-PCR was used to examine the expression of LRP16 in 26 normal endometrium specimens ,10 endometrial cancer specimens .RT-PCR was used for verifying the transfection success .WES-T was used to observe the proliferation change of HEC-1-B cells .Results The positive expression rate and level of LRP16 mRNA in the endometrial cancer tissues were 83 .33% and 0 .82 ± 0 .21 ,which were significantly higher than 30 .00% ,0 .47 ± 0 .18 in the normal endometrium tissues(P<0 .05) .The RT-PCR detection results revealed that the expression of LRP16 mRNA after transfection was significantly increased .HEC-1-B cells in the transfection group could continued to proliferate in vitro ,but the proliferation capacity was not increased .Conclusion The expression abnormality of LRP16 may be closely related to the occurrence and progress of endometrial cancer ,LRP16 gene may have potential value for the endometrial canc-er gene therapy .