Clinical study of 23 cases with pneumocystis pneumonia after allogeneic hematopoietic stem cell transplantation / 中华急诊医学杂志

Objective:To analyze the risk factors,clinical characteristics and prognosis of the pneumocystis pneumonia(PCP) that is one of the severe pulmonary complications after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The clinical features,laboratory data,treatment and outcomes of patients with PCP after allo-HSCT in our hospital from January,2016 to January,2021 were retrospectively collected and analyzed.Results:Twenty three cases who met the clinical diagnostic criteria of PCP were enrolled. The median time of diagnosed as PCP after transplantation was 221 days. The computed tomography (CT) of chest indicated diffuse ground glass opacity.The median of β-1,3-D glucan consentration was 894.25 ng/L, and 91.3% of the cases were over 60 ng/L.The lymphocyte count in 60.9% cases was lower than 1×10 9/L;CD4 +T lymphocyte count in 65.2% of patients was less than 200/μL. Pneumocytis sequences of mNGS were positive in all 21 cases.15 patients were complicated with mixed infection.All patients were treated with TMP-SMX,18 patients were cured and 5 patients died. Conclusions:Patients with PCP after allo-HSCT progresses rapidly, and which is usually with multiple infections. Serum β-1,3-D glucan concentration increase contributes to the diagnosis of PCP.And mNGS in alveolar lavage fluid is highly sensitive to Pneumocystis, which helps patients get treatment in time, so as to reduce mortality.Patients with respiratory failure progressing to a need for mechanical ventilation and high flow oxygen inhalation suggest a poor prognosis.

Síndrome de deprivación glucocorticoidea. A propósito de un caso / Glucocorticoid deprivation syndrome. Case presentation

RESUMEN El síndrome de deprivación glucocorticoidea es el cuadro clínico resultante de la suspensión de la administración exógena de esteroides, aplicados por tiempo prolongado, independientemente de la vía de administración. Provoca la frenación del eje hipotálamo-hipófisis-suprarrenal y por ende disminuye la producción y secreción de corticotropina. Paciente femenina de 54 años de edad, con esteroides como tratamiento prolongado. Al retirarlo comenzó con pérdida de peso y dificultad para caminar, además de hipotensión ortostática, sufrió caída brusca al piso con pérdida de conocimiento. Fue llevada al hospital y no se constató pulsos periféricos ni tensión arterial, que no resolvió totalmente con el uso enérgico de fluidos endovenosos. Se mantuvo sin regular parámetros normales, se reevaluó como un síndrome de depravación corticoidea y se le impuso tratamiento con prednisona, mejorando paulatinamente. Los síndromes asociados a la retirada de corticoidesaparecen por el empleo de dosis altas, o retirada brusca de la corticoterapia prolongada. Al conjunto de síntomas y signos que aparecen cuando no se consigue tolerar la retirada de glucocorticoides, ante la ausencia de enfermedad subyacente para la cual fueron indicados estos medicamentos, y con un eje hipotálamo-hipófisis-suprarenal (HHS) no suprimido se le considera un síndrome de retirada de corticoides. A pesar de la gravedad, la frecuencia e importancia de este efecto secundario, en ocasiones no se repara en él, por lo que es imprescindible valorar los tratamientos indicados y reevaluar periódicamente los tratamientos crónicos indicados.

ABSTRACT The glucocorticoide deprivation symptom is the clinical symptom resulting from stoping the exogenous administration of steroids that were used for a long time, in spite of the administration way. It restrains the hypothalamus-pituitary-adrenal axis and therefore reduces corticotropine production and secretion. This is the case of a female patient, aged 54 years, with a continued steroid treatment. When stoping it, she began to lose weight and presented difficulties for walking. Besides orthostatic hypotension, she abruptly fell to the ground losing conciousness. She was carried to the hospital and there were not found periferal pulses nor arterial tension, a problem that was not solved by the active use of endovenous fluids. She kept on without regulating normal parameters, and was re-evaluated as a corticoid deprivation symptom and treated with prenisone. She gradually got better. The syndromes asociated to corticod deprivation begin due to the usage of high doses, or due to the abrupt withdrawal of a long corticotherapy. The whole of the symptoms appearing when corticoid withdrawal is not tolerated, in the absence of the underlying disease against which these medicines were indicated, and with a non-suppressed hypothalamus-pituitary-adrenal axis, is considered as a syndrome of corticoide withdrawal. In spite of its seriousness, of the frequency and importance of this secundary effect, sometimes it is not noticed; therefore it is essential to evaluate the indicated treatments and periodically reevaluate the treatments ordered for chronic diseases.

Lignan constituents from Balanophora involucrate and their anti-inflammatory activities / 中草药

Objective: To study the chemical constituents in the whole herb of Balanophora involucrate. Methods: The compounds were isolated and purified using polyamide, silica gel colimu, ODS, MCI gel, and semi-preparative HPLC, and their structures were elucidated by means of physicochemical properties and spectroscopic analysis. The anti-inflammatory activities of all the isolated compounds were evaluated using Griess method and ELISA for the determination of LPS-induced NO and IL-6 releases in inflammation cell model induced by LPS. Results: Eleven lignans were isolated from 75% ethyl alcohol extract from the whole herb of B. involucrata and identified as (+)-pinoresinol (1), (+)-5’-hydroxypinoresinol (2), isolariciresinol 4-O-β-D-glucopyranoside (3), (+)-isolariciresinol (4), burselignan (5), (+)-9-acetoxyisolariciresinol (6), yunnanensin A (7), (-)-secoisolariciresinol-4-O-β-D- glucopyranoside (8), (-)-secoisolariciresinol (9), dihydrocubebin (10), and secoisolariciresinol-9’-acetate (11). Conclusion: Among them, compound 11 is a new natural product, and compound 2, 5, 7, 8, and 10 are isolated from the genus of Balanophora for the first time. All compounds showed strong anti-inflammatory activities.

Study on chemical constituents from roots of Lycium chinense / 中草药

Objective: To study the chemical constituents from the roots of Lycium chinense. Methods: The compounds were isolated and purified by silica gel, ODS and Sephadex LH-20 chromatography in addition to preparative-HPLC. Their structures were elucidated on the basis of physicochemical properties and spectral analysis. Results: Twelve compounds were isolated from the EtOAc fraction of the root of Lycium chinense and identified as grossamide K (1), grossamide (2), dihydrogrossamide (3), cannabisin H (4), 1,2-dihydro-6,8-dimethoxy-7-hydroxy-1-(3,4-dihydroxyphenyl)-N1,N2-bis [2-(4-hydroxyphenyl)ethyl]-2,3-naphthalene dicarboxamide (5), cannabisin D (6), (1,2-trans)-N3-(4-acetamidobutyl)-1-(3,4-dihydroxyphenyl)-7-hydroxy-N2-(4-hydroxyphenethyl)-6,8-dimethoxy- 1,2-dihydronaphthalene-2,3-dicarboxamide (7), cannabisin F (8), (E)-2-(4,5-dihydroxy-2-{3-[(4-hydroxyphenethyl)amino]-3-oxopropyl} phenyl)-3-(4-hydroxy-3-methoxyphenyl)-N-(4-acetamidobutyl)acrylamide (9), (E)-2-(4,5-dihydroxy-2-{3-[(4-hydroxylphenethyl) amino]-3-oxopropyl}phenyl)-3-(4-hydroxy-3,5-dimethoxyphenyl)-N-(4-hydroxyphenethyl)acrylamide (10), (+)-lyoniresinol-3α-O-β-D- glucopyranoside (11), and (−)-lyoniresinol-3α-O-β-D-glucopyranoside (12). Conclusion: Compound 3 is a new natural product. Compounds 1, 2, and 4—8 are isolated from this plant for the first time.

Biotransformation and antitumor activity of triterpenoid derivatives from Ardisia gigantifolia / 中草药

Objective: To study the chemical constituents of transformed products by Sphingomonas yabuuchiae GTC 868T (AB071955) and Pectinex Ultra AFP from the saponin of Ardisia gigantifolia. Methods: Transformation products separated by the process of silica gel column, compounds were identified and elucidated by spectral and chemical methods. Their cytotoxicity activities were tested by Cell Counting Kit 8 colorimetric assay. Results: Five triterpenoid saponins were obtained, including 3β-O-{α-L-rhamnopyranosyl-(1→3)-[β-D-xylopyranosyl-(1→2)]-β-D-glucopyranosyl-(1→4)-α-L-arabinopyranosyl}-cyclamiretin A (1), 3β-O-{β-D-glucopyranosyl-(1→4)-[β-D-glucopyranosyl-(1→2)]-α-L-arabinopyranoside}-cyclamiretin A (2), 3β-O-{β-D-glucopyranosyl-(1→2)-α-L-arabinopyranoside}-cyclamiretin A (3), 3-O-α-L-arabinopyranosyl cyclamiretin A (4), and cyclamiretin A (5). Conclusion: Compounds 2-5 are obtained by biotransformation for the first time. Some of the compounds showed certain antitumor activity, among them, compound 2 shows more cytotoxicity activity than Ag3 and positive control.

Establishment of Mouse Models with Kidney-positive Deficiency with Antisense Oligonucleotide-loaded Bio-degradable Polylactic Acid Microspheres / 中国药房

OBJECTIVE:To investigate the feasibility of mouse models establishment with kidney-positive deficiency with anti-sense oligonucleotide-loaded biodegradable polylactic acid microspheres. METHODS:Three-week old mice were randomized into groups A,B,C,D and E,with 6 mice in each group,where the mice in group A were given subcutaneous injection 0.2 ml nor-mal saline,and those in groups B-E were given subcutaneous injection 0.1,0.2,0.4 and 0.8 mg each mice of antisense oligonucle-otide-loaded biodegradable polylactic acid microspheres. After the administration,the weights and activities of mice in all groups were observed;and one month later,their livers,adrenal glands and brains were collected to detect the expression of glucocorti-coid receptor (GR) by real-time quantitative polymerase chain reaction (RT-PCR). RESULTS:All mice except those in group A were found to have kidney-positive deficiency symptoms such as developmental delay,light weight,less activities and gathering to-gether. Compared to group A,other groups showed lower GR expressions in liver,adrenal gland and brain. There was statistically difference (P<0.05). CONCLUSIONS:Antisense oligonucleotide-loaded biodegradable polylactic acid microspheres can inhibit GR expression,and the mice whose GR expression is inhibited show symptoms of kidney-positive deficiency,which provides a re-ference for the establishment of mouse models with kidney-positive deficiency.

Studies on chemical constituents of Drynaria roosii / 中草药

Objective: To investigate the chemical constituents from the rhizomes of Drynaria fortunei. Methods: The compounds were purified by silica gel, ODS, Sephadex LH-20 column chromatography, and preparative HPLC, and their structures were identified on the basis of chemical and spectroscopic methods, such as MS and NMR. Results: Seven compounds were isolated from the 75% ethanol extract and identified as 12-O-caffeoyl-12-hydroxyldodecanoic acid methyl ester (1), p-hydroxy benzenepropanoic acid (2), 3,4-dihydroxyphenyl ethyl 8-O-β-D-allopyranoside (3), luteolin 7-O-β-D-glucopyranoside (4), psoralen (5), protocatechoic acid (6), and caffeic acid (7). Conclusion: Compound 1 is a new compound, named drynalkylester A, and compounds 2-5 are obtained from the plants of Drynaria Willd. for the first time.

Chemical Constituents with Antihyperlipidemic Activities from Desmodium triquetrum / 中草药·英文版

Objective: To study the chemical constituents from Desmodium triquetrum and their antihyperlipidemic activities. Methods: The constituents of D. triquetrum were isolated and purified using various column chromatographies. Their chemical structures were elucidated using extensive spectroscopic methods. The lipid-lowering effects of the isolates were evaluated in HepG2 cells. Results: Nine compounds were obtained from the ethanol extract of D. triquetrum and determined to be 6'-. O-cis-p-coumaroyl-3,5-dihydroxyphenyl-β-. D-glucopyranoside (1), tadehaginoside (2), rutin (3), quercetin-3-O-β-. D-glucopyranoside (4), quercetin-3-O-β-. D-galactopyranoside (5), 6-. O-(E)-. p-hydroxy-cinnamoyl-β-glucose (6), 6-. O-(E)-. p-hydroxy-cinnamoyl-α-glucose (7), kaempferol-3-O-β-. D-rutinoside (8), and 3-. O-β-D-galacopyranosyl (6-1)-α-. L-rhamnosyl quercetin (9). Compounds 1 and 2 significantly reduced the intracellular content of total cholesterols and triglycerides. Conclusion: Compound 1 is a new phenolic compound and exhibits potent anti-hyperlipidemic activity. Additionally, compounds 6 and 7 are isolated from D. triquetrum for the first time.

Avaliação da pectina fosfatada aplicada na formação de filmes isolados: material candidato a novos sistemas para liberação modificada de fármacos / Phosphated pectin application in the development of films for drug delivery systems: evaluation of permeability properties and swelling

Pectina fosfatada (Pect-TMFT) juntamente com o α-Gluco-oligossacarídeo (Bioecolians®) foram incorporados à dispersão aquosa de polimetacrilato (Eudragit® RS 30 D) para obtenção de filmes isolados pelo processo "casting" (50 ºC) em placa de Teflon®. A Pect-TMFT e o Bioecolians® foram adicionados à dispersão de Eudragit® RS 30 D nas concentrações: 90: 05: 05, 80: 10: 10 e 70: 20: 10 (4 por cento p/v). Citrato de trietila (TEC) foi utilizado como plastificante (20 por cento da massa do polimetacrilato). As dispersões propostas apresentaram habilidades filmogênicas. Os filmes isolados foram caracterizados pela determinação da permeabilidade ao vapor d'água (TVA), pelo índice de intumescimento (Ii por cento) em fluidos de simulação gástrica (FSG) e intestinal (FSI) e por microscopia eletrônica de varredura (MEV). O aumento do polissacarídeo modificado e do Bioecolians® nos filmes favoreceram a permeabilidade ao vapor d'água e o grau de hidratação quando em FSI (pH= 6,8). Dessa forma, o filme 70: 20: 10, poderá impedir a liberação prematura do fármaco em regiões superiores do TGI quando aplicado como revestimento de sistemas sólidos orais. Além disso, a presença da Pect-TMFT e do Bioecolians®, poderá favorecer a degradação específica da película por enzimas produzidas pela microflora colônica, possibilitando uma cinética de liberação modificada de fármacos apesar das variações inter-individuais de pH que possam existir.

Phosphated pectin (Pect-TMFT) together with α-gluco-oligossacaride (Bioecolians®) were incorporated into aqueous dispersion of polymethacrylate (Eudragit® RS 30 D) to obtain free films by the casting process (50ºC) in Teflon® plate. Pect-TMFT and Bioecolians® were added into dispersions of Eudragit ® RS 30 D at different rates: 90:05:05, 80:10:10 and 70:20:10 (4 percent p/v). Triethyl citrate (TEC) was used as plasticizer (20 percent of mass of the polymethacrylate). The proposed dispersions showed film formation ability. The free films were characterized by the determination of water vapour transmission (WVT), by the swelling index (Ii percent) in fluids of gastric simulation (FGS) and intestinal (FIS) and by scanning electron microscopy (SEM). The increase of modified polysaccharide and Bioecolians® in the films favored their permeability to the water vapour and their hydration degree when in FIS (pH = 6.8). In that way, the obtained film in the concentration 70:20:10, can prevent the premature release of the drug in the up GIT when applied to develop oral solid systems coating. Besides, the presence of Pect-TMFT and Bioecolians® can contribute to the specific membrane degradation by colonic microflora enzymes, making possible a modified release kinetics of drugs even with the existence of inter-individual variations of pH.

Clinical experience with an implanted closed-loop insulin delivery system

AIM: To report the first clinical experience with a prototype of implanted artificial beta-cell. METHODS: The Long-Term Sensor System® project assessed the feasibility of glucose control by the combined implantation of a pump for peritoneal insulin delivery and a central intravenous glucose sensor, connected physically by a subcutaneous lead and functionally by PID algorithms. It was performed in 10 type 1 diabetic patients from 2000 to 2007. RESULTS: No harmful complication related to implants occurred. Insulin delivery was affected by iterative but reversible pump slowdowns due to insulin precipitation. Glucose measurement by the intravenous sensors correlated well with meter values (r = 0.83-0.93, with a mean absolute deviation of 16.5 percent) for an average duration of 9 months. Uploading of pump electronics by PID algorithms designed for closed-loop insulin delivery allowed in-patient 48 hourtrials. CONCLUSION: Although the concept of a fully implantable artificial beta-cell has been shown as feasible, improvements in the sensor structure to increase its longevity and decrease sensor delay that affected closed-loop control at meal-times are expected.

OBJETIVO: Relatar a primeira experiência clínica com um protótipo de célulabeta artificial implantável. MÉTODOS: O Projeto de Um Sistema Sensor de Longo Prazo avaliou a possibilidade do controle glicêmico através do implante combinado de uma bomba de infusão de insulina peritoneal e um gluco - sensor endovenoso central - conectados fisicamente por um dispositivo subcutâneo e funcionalmente por algoritmos PID (integral and derivative). Este projeto envolveu 10 pacientes com diabetes melito tipo 1 de 2000 a 2007. RESULTADOS: Complicações significativas relacionadas aos implantes não ocorreram. A liberação de insulina pela bomba sofreu o efeito de períodos de lentificação interativo, mas reversível, devido a precipitação do peptídeo. As medidas da glicose pelo sensor endovenoso mostraram boa correlação com os valores do glicosímetro (r = 0,83-0,93, com desvio médio absoluto de 16,5 por cento) durante período médio de 9 meses. Os dados para construção dos algoritmos PID do sistema de alça fechada de liberação de insulina foram obtidos a partir de 12 pacientes que permaneceram internados com esse sistema durante 48 horas com refeições que continham 40 a 70 g de carboidratos. CONCLUSÃO : Embora o conceito de uma célula-beta artificial totalmente implantável tenha demonstrado ser possível, aperfeiçoamentos são necessários na estrutura do sensor para aumentar a sua longevidade e no sistema de alça fechada de liberação de insulina para diminuir as lentificações que comprometem o controle glicêmico nos períodos relacionados às refeições.

EFFECT OF TOTAL GLUCOSIDES OF PAEONY ON LEUKOTRIENE B_4 BY PERITONEAL MACROPHAGES IN RATS / 中国药理学通报

Total glucosides of paeony ( TGP ) , an extract of Paeonia Lacti-flora Pall were investigated for its effect on the synthesis of leukotriene B_4 ( LTB_4 ) by peritoneal macrophages ( PM?). LTB4, generated by 10~9~15 ? 10~10/L PM? with ionophore A_23187 , were measured with RP-HPLC. Suppression of releasing LTB_4 from PM? by TGP ( 100 mg/L ) was as much as the same dose of Flufenamic acid, but the action of TGP was slower. TGP significantly inhibited the synthesis of LTB_4 by PM? in a dose-dependent manner. The concentration of TGP required to obtain 50% inhibition ( IC_50 ) of formation of LTB_4 was 0.66mg/L. The data suggested antiinflam-matory and immunomodulatory action of TGP were related to its suppression of releasing LTB_4

AN EXPERIMENTAL RESEARCH ON THE ANTI-OBESITY EFFECT OF KONJAC FLOUR / 营养学报

The Konjac flour (KF) was from Amorphallus Konjac, a kind of food, rich in dietary fibre composed mainly of gluco-mannan, but trace protein and very low energy.Male and female Spraue-Dawley rats aged 24 days were divided into 3 groups. All 3 groups were fed with high lipid and high nutrition diet. The group A was set as control, group B and group C plus KF in diet daily oral dose of 1.9mg/g and 19mg/g body weight respectively.After 45 days feeding, the following results were obtained;1. The increases of body weight in rats were reduced by oral KF.2. The size of fat cells in abdominal tissue and fat weight were greater in control group than in the other groups. These results suggest that KF has a significant effect on reducing obesity.3. No significant differences were found among the three groups in serum of chol, TG and some elements.4. The moist faeces in the KF groups were greater than the control group5. No side effects were found on the tests.