Time to sputum culture conversion and its associated factors among drug-resistant tuberculosis patients: a systematic review and meta-analysis.

OBJECTIVE: We aimed to evaluate the sputum culture conversion time of DR-TB patients and its related factors. METHODS: PubMed, The Cochrane Library, Embase, CINAHL, Web of Science, CNKI, Wan Fang, CBM and VIP databases were electronically searched to collect studies on sputum culture conversion time in patients with DR-TB. Meta-analysis was performed by using the R 4.3.0 version and Stata 16 software. RESULTS: A total of 45 studies involving 17373 patients were included. Meta-analysis results showed that the pooled median time to sputum culture conversion was 68.57 days (IQR 61.01,76.12). The median time of sputum culture conversion in patients with drug-resistant tuberculosis was different in different WHO regions, countries with different levels of development and different treatment schemes. And female (aHR = 0.59,95%CI: s0.46,0.76), alcohol history (aHR = 0.70,95%CI:0.50,0.98), smoking history (aHR = 0.58,95%CI:0.38,0.88), history of SLD use (aHR = 0.64,95%CI:0.47,0.87), BMI < 18.5 kg/m2 (aHR = 0.69,95%CI:0.60,0.80), lung cavity (aHR = 0.70,95%CI:0.52,0.94), sputum smear grading at baseline (Positive) (aHR = 0.56,95%CI:0.36,0.87), (grade 1+) (aHR = 0.87,95%CI:0.77,0.99), (grade 2+) (aHR = 0.81,95%CI:0.69,0.95), (grade 3+) (aHR = 0.71,95%CI:0.61,0.84) were the related factor of sputum culture conversion time in patients with DR-TB. CONCLUSION: Patients with DR-TB in Europe or countries with high level of economic development have earlier sputum culture conversion, and the application of bedaquiline can make patients have shorter sputum culture conversion time. Female, alcohol history, smoking history, history of SLD use, BMI < 18.5 kg/m2, lung cavity, sputum smear grading at baseline (Positive, grade 1+, grade 2+, grade 3+) may be risk factors for longer sputum culture conversion time. This systematic review has been registered in PROSPERO, the registration number is CRD42023438746.

The heart-lung machine in major limb replantation: Report of two cases.

Replantation of amputated limbs after long ischemic hours almost always comes with reperfusion syndrome and poor outcomes. An ischemic time of greater than 6 h is often considered unsuitable for major limb replantation. However, usage of extracorporeal perfusion has been shown to prolong the viability of major limbs in animal studies. The aim of this report is to show that extracorporeal perfusion with cardiopulmonary bypass machine (CPBM) is a safe and reliable technique in improving limb survival as illustrated by our cases. We report two cases of successful major limb replantation with late presentation. One case involved a 31-year-old man with shoulder disarticulation and the other involved a 30-year-old man sustained proximal transtibial amputation. Both patients, who were generally fit, were involved in major road traffic accidents. The amputated segments were connected to a CPBM to expedite reperfusion and to flush away anaerobic metabolic products. The major vessels were cannulated and connected to a bypass machine that was initially primed with heparinized saline and perfused with packed cells at 100% oxygen concentration. The perfusion was carried out at 35°C with low pressure to prevent edema and low flow to reduce reperfusion injury. Venous blood was drained completely before replantation. Total ischemia times were 7 h 40 min and 9 h, respectively. No evidences of perioperative reperfusion syndrome were seen. Both of the replanted limbs survived and patients had regained better-than-expected limb functional outcomes at 5-year and 2-year follow-up, respectively. CPBM may be safely used in major replantation surgery to enhance limb survival and therefore warrants further research.

Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation.

Spontaneous intracranial hypotension (SIH) occurs due to a leakage of the cerebrospinal fluid (CSF) lowering the pressure of subarachnoid space, mostly caused by a dural breach or discogenic microspur. As a result of less support provided by CSF pressure, intracranial structures are stretched downward, leading to a constellation of more or less typical MRI findings, including venous congestion, subdural effusions, brainstem sagging and low-lying cerebellar tonsils. Clinic examination and an MRI are usually enough to allow for the diagnosis; however, finding the location of the dural tear is challenging. SIH shares some MRI features with Chiari malformation type I (CM1), especially low-lying cerebellar tonsils. Since SIH is likely underdiagnosed, these findings could be interpreted as signs of CM1, leading to a misdiagnosis and an incorrect treatment pathway. Medical treatment, including steroids, bed rest, hydration caffeine, and a blind epidural blood patch, have been used in this condition with variable success rates. For some years, CSF venous fistulas have been described as the cause of SIH, and a specific diagnostic and therapeutic pathway have been proposed. The current literature on SIH with a focus on diagnosis, treatment, and differential diagnosis with CM1, is reviewed and discussed.

Study on the status quo and correlation between body image and stigma of drug-resistant tuberculosis patients treated with Clofazimine / 中国实用护理杂志

Objective:To investigate the current situation of body image and stigma of drug-resistant tuberculosis patients treated with Clofazimine, and analyze the correlation between them.Methods:A cross-sectional study was conducted using convenience sampling method to investigate 150 patients with drug-resistant tuberculosis treated with Clofazimine in tuberculosis ward of Chengdu Public Health Clinical Medical Center from October 2020 to October 2021. The general questionnaire, Body Image Scale (BIS) and Tuberculosis Related Stigma Scale were used to conduct a questionnaire survey.Results:A total of 130 questionnaires were effectively collected. The body image score of 130 patients with drug-resistant tuberculosis treated with Clofazimine was (20.51 ± 6.80) points; the score of stigma was (17.78 ± 6.92) points. There was a positive correlation between the total score of disease shame and the total score of body image ( r=0.544, P<0.05). Conclusions:Patients with drug-resistant tuberculosis treated with Clofazimine have body image disorder and stigma, and the two are positively correlated. Caregivers should carry out psychological assessment and intervention at an early stage to improve the patient′s mental health level.

Genomic structure of varicella-zoster virus and its vaccine application status / 中华预防医学杂志

With the determination of the whole genome sequence of varicella-zoster virus (VZV) virus, the successful breakthrough of infectious cloning technology of VZV, and the emergence of effective preventive vaccines, which have been proven to be effective and safe, varicella has become a disease preventable by specific immunity. This article will review the genomic structure, epidemiological characteristics, and research application progress of varicella vaccine and herpes zoster vaccine of varicella zoster virus to provide reference for primary prevention of the disease.

Knowledge and Perceptions on End-of-life Care among End-stage Renal Disease Patients on Hemodialysis.

The role of end-of-life care is fundamental for end-stage renal disease (ESRD) patients, who are known to have a high morbidity and mortality rate despite being on dialysis. This requires effective communication and shared decision-making. Thus, exploring patients' knowledge and perceptions is essential to improve the gaps in delivering end-of-life care. This study aimed to describe the knowledge and perceptions of end-of-life care among ESRD patients on hemodialysis (HD). This was a cross-sectional study involving 14 outpatient HD centers in Kuantan, Malaysia. Patients were recruited from March to June 2019. A validated questionnaire was delivered via interview-based surveys by the researcher or trained interviewers. The majority of the respondents had poor knowledge of the disease and end-of-life care. However, more than 70% of the respondents felt that it was important for them to be actively involved in medical decision-making, as well as being prepared and planning for death. End-of-life needs, which included management of symptoms and psychological, social, and spiritual support, were important to most respondents. Additionally, patients with higher educational backgrounds were observed to have higher scores for both knowledge and perceptions (P <0.05). The study found poor knowledge but acceptable perceptions among patients. This highlights the gaps in the current local approach in clinical practice to end-of-life care in ESRD.

Study of a multicriteria value assessment index system for hospital access of medical consumables / 中华医院管理杂志

Objective:To establish a multicriteria value assessment index system, so as to provide reference for hospitals access of medical consumables.Methods:In May 2021, based on the paper previously published, the expert consultation method was used to finalize the index structure, index definitions and scoring standards, along with an importance grading of the indexes. And the index weights were calculated using the analytical hierarchy process. Then the assessment scale was designed by way of multi-criteria decision analysis and mini-HTA. With the linear cutting stapler used as an example, six clinicians, three hospital administrators and the medical consumable management committee made an empirical analysis and evaluation of its general value. The coefficient of variation and Kendall coefficient of concordance were used to test the consistency of clinicians′ scores.Results:Three rounds of expert consultations finalized an index structure with 4 level-1 and 11 level-2 indexes, and on such basis a multicriteria value assessment index system for hospital access of medical consumables was established. This system comprised the clinician evaluation scale, hospital administrator evaluation scale and medical consumable management committee evaluation scale. The first two of which were used for preliminary screening, and the third for a full-scale, detailed and quantitative evaluation of those selected, hence a decision was made in the end according to the weighted sum of the three scales. This scale system was used to evaluate a foreign brand and a domestic brand of linear cutting staplers, while the former and the latter scored 90.5 and 75.4 respectively. Statistical analysis of the six clinicians found a coefficient of variation CV<0.25, and the Kendall coefficient of concordance W=0.833, proving good consistency of the evaluation criteria and results. Conclusions:The multicriteria value assessment index system proves highly scientific, comprehensive and practicable, serving a good reference for hospitals to build their value-based mechanism to select medical consumables.

Nanostructure Engineering via Intramolecular Construction of Carbon Nitride as Efficient Photocatalyst for CO2 Reduction.

Light-driven heterogeneous photocatalysis has gained great significance for generating solar fuel; the challenging charge separation process and sluggish surface catalytic reactions significantly restrict the progress of solar energy conversion using a semiconductor photocatalyst. Herein, we propose a novel and feasible strategy to incorporate dihydroxy benzene (DHB) as a conjugated monomer within the framework of urea containing CN (CNU-DHBx) to tune the electronic conductivity and charge separation due to the aromaticity of the benzene ring, which acts as an electron-donating species. Systematic characterizations such as SPV, PL, XPS, DRS, and TRPL demonstrated that the incorporation of the DHB monomer greatly enhanced the photocatalytic CO2 reduction of CN due to the enhanced charge separation and modulation of the ionic mobility. The significantly enhanced photocatalytic activity of CNU-DHB15.0 in comparison with parental CN was 85 µmol/h for CO and 19.92 µmol/h of the H2 source. It can be attributed to the electron-hole pair separation and enhance the optical adsorption due to the presence of DHB. Furthermore, this remarkable modification affected the chemical composition, bandgap, and surface area, encouraging the controlled detachment of light-produced photons and making it the ideal choice for CO2 photoreduction. Our research findings potentially offer a solution for tuning complex charge separation and catalytic reactions in photocatalysis that could practically lead to the generation of artificial photocatalysts for efficient solar energy into chemical energy conversion.

Analysis of differentially expressed proteins between HER2 positive and triple negative breast cancer and their prognostic significance.

Both triple negative breast cancer (TNBA) and HER2-positive breast cancer lack expression of estrogen receptor alpha (ER) and progesterone receptor (PR), while human epidermal growth factor receptor 2 (HER2) in TNBC is also negative. This study aimed to identify the differentially expressed proteins (DEPs) between TNBC and HER2-positive breast cancer and to improve understanding of their role in the prognosis of breast cancer. By analyzing the breast cancer data set in The Cancer Proteome Atlas (TCPA) database, 15 DEPs between TNBC and HER2-positive breast cancer were identified. GO and pathway enrichment analysis were performed on DEPs, and the protein-protein interaction (PPI) network was constructed. The overall survival (OS) analysis of the breast cancer protein dataset in the Kaplan-Meier plotter showed that low expression of ACC1 suggested a higher OS of HER2-positive breast cancer (HR = 5.34, P < 0.05) and TNBC (HR = 2.88, P < 0.05). And TNBC patients with high TBA1B (HR = 0.16, P < 0.01) or low INPP4B (HR = 3.47, P < 0.05) expression have a better prognosis. Our research provides new insights into the prognostic indicators of TNBC and HER2-positive breast cancer, which could be further studied.

Descriptive Regional Subanalysis of a Real-World Study in Patients with Type 2 Diabetes Treated with Gliclazide MR During Fasting: DIA-RAMADAN.

INTRODUCTION: To analyse the safety and effectiveness of gliclazide modified release (MR) in adults with type 2 diabetes mellitus participating in Ramadan from three geographically and culturally different regions of the world included in the DIA-RAMADAN study. METHODS: DIA-RAMADAN was a real-world, observational, international, non-comparative study. The global study population was divided into three regional subgroups, with data gathered at inclusion 6-8 weeks prior to Ramadan (V0), during Ramadan (4.5 weeks) and 4-6 weeks after Ramadan (V1). Primary endpoint was the proportion of patients reporting ≥ 1 symptomatic hypoglycaemic events (HE), which were collected using a patient diary along with other adverse events. RESULTS: Patient numbers from the three regions were n = 564 (46.5%; Indian sub-continent), n = 354 (29.1%; Middle East) and n = 296 (24.4%; South-East Asia). Patient baseline characteristics, demographics, fasting habits and antidiabetic treatments varied between regions. There were similar proportions of symptomatic HE between regions, with no severe HE. Significant weight reductions were observed in all regions following Ramadan, along with reductions in HbA1c and fasting plasma glucose. CONCLUSION: These real-world study data indicate that gliclazide MR is safe and effective for management of type 2 diabetes during Ramadan in all three regions studied as part of DIA-RAMADAN. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT04132934. INFOGRAPHIC.

LINC00339 regulates proliferation, invasion and apoptosis of colon cancer cells by increasing expression of COMP via absorbing miR-873-5p / 中国药理学通报

Aim To investigate the effects of long non coding RNA (LncRNA) LINC00339 on proliferation, invasion and apoptosis of colon cancer (CC) cells through regulating miR-873-5p/COMP axis. Methods qRT-PCR was used to detect the expression of LINC00339, miR-873-5p and COMP in CC tissues and cells. Cell proliferation, invasion and apoptosis were detected by means of CCK-8, Transwell and flow cytometry respectively. The targeting relationship between miR-873-5p and LINC00339 as well as COMP was verified by dual luciferase reporter gene assay and RNA pull-down. Results Compared with paracancer-ous tissues and normal colonic epithelial cells, the expressions of LJNC00339 and COMP were up-regulated while the expression of miR-873-5p was down-regulated in CC tissues and cells (all P < 0. 05). LINC00339 up-regulated the expression of COMP via competitive binding with miR-873-5p. Down-regulation of LINC00339 inhibited the proliferation and invasion of CC cells and induced cell apoptosis, but the effects of LINC00339 knockdown on the biological behavior of CC cells was partially saved by miR-873-5p inhibitor (all P < 0. 05). LINC00339 increased the expression level of COMP via absorbing miR-873-5p, and the up-regulation of COMP partially saved the effects of LINC00339 knockdown on CC cells (all P <0.05). Conclusions LINC00339 promotes the proliferation and invasion while inhibits apoptosis of CC cells through regulating miR-873-5p/COMP axis.

Impact of chemotherapy schedule modification on breast cancer patients: a single-centre retrospective study.

Background Nonconformity to chemotherapy schedules is common in clinical practice. Multiple clinical studies have established the negative prognostic impact of dose delay on survival outcome. Objective This study investigated the prevalence and reason for chemotherapy schedule modifications of breast cancer patients. This study also investigated the impact of schedule modifications on overall survival (OS). Setting This retrospective cohort study was done among breast cancer patient receiving chemotherapy from 2013 to 2017 and patients were followed until 31 Dec 2018. Methods Medical records of patients with cancer were reviewed. Female patients over eighteen years old were included, with primary carcinoma of the breast, who received anthracycline or taxane based chemotherapy regime and completed more than two cycles of chemotherapy. Patients were categorized into three groups of (1) no schedule modification, (2) with schedule modification and (3) incomplete schedule. The Kaplan-Meier was used to test for survival differences in the univariate setting and Cox regression model was used in the multivariate setting. Main outcome measure Prevalence, overall survival rates and hazard ratio of three schedule group Results Among 171 patient who were included in the final analysis, 28 (16.4%) had no schedule modification, 118 (69.0%) with schedule modification and 25 (14.6%) had incomplete schedule with OS of 75.0%, 59.3% and 52.0% respectively. 94% (189) of all cycle rescheduling happened because of constitutional symptoms (70), for non-medical reasons (61) and blood/bone marrow toxicity (58). When compared to patients with no schedule modification, patients with schedule modification had a 2.34-times higher risk of death (HR 2.34, 95% CI 1.03-5.32; p = 0.043). Conclusion Nonconformity to the chemotherapy schedule is common in clinical practice because of treatment complications, patients' social schedule conflicts, and facility administrative reasons. Cumulative delays of ≥ 14 days are likely to have negative prognostic effect on patient survival. Thus, the duration of the delays between cycles should be reduced whenever possible to achieve the maximum chemotherapeutic benefit.

Expression and role of Pim1 in cultured cortical neurons with oxygen-glucose deprivation/reoxygen injury / 中国当代儿科杂志

OBJECTIVE@#To study the expression and effect of Pim1 in primary cortical neurons after hypoxic-ischemic injury.@*METHODS@#Cortical neurons were isolated from 1-day-old C57BL/6 mice and cultured in neurobasal medium. On the 8th day of neuron culture, cells were subjected to oxygen-glucose deprivation/reoxygen (OGD/R) treatment to mimic in vivo hypoxic injury of neurons. Briefly, medium were changed to DMEM medium, and cells were cultured in 1% O for 3 hours and then changed back to normal medium and conditions. Cells were collected at 0 hour, 6 hours, 12 hours and 24 hours after OGD/R. Primary neurons were transfected with Pim1 overexpression plasmid or mock plasmid, and then were exposed to normal conditions or OGD/R treatment. They were named as Pim1 group, control group, OGD/R group and OGD/R+Pim1 group respectively. Real-time PCR was used to detect Pim1 mRNA expression. Western blot was used to detect the protein expression of Pim1 and apoptotic related protein cleaved caspase 3 (CC3). TUNEL staining was used to detect cell apoptosis.@*RESULTS@#Real-time PCR and Western blot results showed that Pim1 mRNA and protein were significantly decreased in neurons after OGD/R. They began to decrease at 0 hour after OGD/R, reached to the lowest at 12 hours after OGD/R, and remained at a lower level at 24 hours after OGD/R (P<0.01). Overexpression of Pim1 significantly upregulated the protein level of Pim1. Under OGD/R conditions, the CC3 expression and the apoptosis rate in cells of the Pim1 group were significantly lower than in un-transfected cells (P<0.01).@*CONCLUSIONS@#Hypoxic-ischemic injury may decrease Pim1 expression in neurons. Overexpressed Pim1 may inhibit apoptosis induced by OGD/R.

A verification study of Offset values of different applicators in afterloading brachytherapy / 中华放射肿瘤学杂志

Objective To investigate the Offset values of different applicators in afterloading brachytherapy.Methods Six types of applicators were selected in this study which included stainless steel interstitial needle (Part#083.062),proguide round needle (Part#189.608),proguide sharp needle (Part# 189.601),vaginal multi-channel applicator (Part # 110.800),fletcher CT/MR applicator (Part # 189.745)and henschke titanium applicator (Part#110.437).According to the sources imaging in the fluorography film,the distance of applicators between the first dwell position and the top could be measured.Marker was pasted on the surface of applicator corresponding to the first dwell position.And then the applicator was put into the pelvic phantom for a CT scan.During applicator reconstruction in the treatment planning system,the Offset values of all applicators could be acquired through adjusting the value of offset to superimpose the first dwell and the marker images.On account of the density of plastic material applicators were similar to human tissues,it was difficult to reconstruct the top of the applicator.With the help of stopper or simulation source,the value of offset could be acquired for plastic material applicators.Based on the measurement results,the differences were analyzed among different applicators.Results The Offset values significantly differed among various applicators.The Offset value for stainless steel interstitial needle was-11.4 mm,-4.1 mm for proguide round needle,-3.5 mm for proguide sharp needle,0 mm or-5.0 mm for vaginal multi-channel applicator,-6.5 mm for fletcher CT/MR applicator and-7.5 mm for henschke titanium applicator,respectively.Conclusion To adapt to the rapid development of precise radiotherapy,it is necessary to verify the Offset value in afterloading brachytherapy.

A verification study of Offset values of different applicators in afterloading brachytherapy / 中华放射肿瘤学杂志

Objective@#To investigate the Offset values of different applicators in afterloading brachytherapy.@*Methods@#Six types of applicators were selected in this study which included stainless steel interstitial needle (Part#083.062), proguide round needle (Part#189.608), proguide sharp needle (Part#189.601), vaginal multi-channel applicator (Part#110.800), fletcher CT/MR applicator (Part#189.745) and henschke titanium applicator (Part#110.437). According to the sources imaging in the fluorography film, the distance of applicators between the first dwell position and the top could be measured. Marker was pasted on the surface of applicator corresponding to the first dwell position. And then the applicator was put into the pelvic phantom for a CT scan. During applicator reconstruction in the treatment planning system, the Offset values of all applicators could be acquired through adjusting the value of offset to superimpose the first dwell and the marker images. On account of the density of plastic material applicators were similar to human tissues, it was difficult to reconstruct the top of the applicator. With the help of stopper or simulation source, the value of offset could be acquired for plastic material applicators. Based on the measurement results, the differences were analyzed among different applicators.@*Results@#The Offset values significantly differed among various applicators. The Offset value for stainless steel interstitial needle was -11.4 mm, -4.1 mm for proguide round needle, -3.5 mm for proguide sharp needle, 0 mm or -5.0 mm for vaginal multi-channel applicator, -6.5 mm for fletcher CT/MR applicator and -7.5 mm for henschke titanium applicator, respectively.@*Conclusion@#To adapt to the rapid development of precise radiotherapy, it is necessary to verify the Offset value in afterloading brachytherapy.

Effects of occupational sunlight exposure and monsoon season on vitamin D concentration among outdoor and indoor workers in Malaysia

@#Introduction: Despite abundant sunshine for cutaneous vitamin D synthesis, low levels of vitamin D have been documented among the Malaysian population. The aim of this study was to characterise the effects of occupational sunlight exposure and monsoon season on serum 25-hydroxyvitamin D [25(OH)D] concentration. Methods: A comparative cross-sectional study was performed among Malay outdoor (n=119) and indoor workers (n=119) in Kelantan. Two-point data were collected on the same participants, first during non-monsoon season and second during the northeast monsoon season. Data collection comprised of anthropometry measurements (body mass index and body fat), fasting blood test [serum 25(OH)D concentration], and questionnaire (physical activity level, sun exposure, sun protection use, and vitamin D intake). Vitamin D classification was based on the 2011 Endocrine Society Clinical Practice Guidelines. Results: This study found that serum 25(OH)D concentrations were significantly higher in outdoor compared to indoor workers irrespective of season (p<0.001) and sex (p<0.001). Monsoonal differences in serum 25(OH)D concentration was only observed in male outdoor workers (mean difference=10.39 nmol/l, p<0.001). Significant association between vitamin D status and occupation was also observed (p<0.001). However, no significant association was found between vitamin D status and monsoon season [χ2(1)=0.076, p=0.783]. Conclusion: Seasonal and occupational factors should be considered while evaluating individual serum 25(OH)D concentration and in comparing community studies, especially among workers.

TRAF1 meditates lipopolysaccharide-induced acute lung injury by up regulating JNK activation.

Acute lung injury (ALI) is served as a severe life-threatening disease. However, the pathogenesis that contributes to ALI has not been fully understood. Tumor necrosis factor receptor-associated factor 1 (TRAF1) interacts with multiple regulators, performing its diverse role in biological functions. However, the effects of TRAF1 on ALI remain unknown. In this study, we attempted to explore the role of TRAF1 in ALI progression. The findings suggested that TRAF1-knockout (KO) markedly attenuated LPS-induced severe mortality rate in murine animals. LPS-elicited histological alterations in pulmonary tissues were significantly alleviated by TRAF1-deletion. Additionally, TRAF1 knockout effectively attenuated lung injury, as evidenced by the reduced lung wet/dry (W/D) weight ratio, as well as decreased bronchoalveolar lavage fluid (BALF) protein levels and neutrophil infiltration. Meanwhile, TRAF1 deletion markedly lessened inflammation, oxidative stress and apoptosis in BALF and/or lung tissues. The levels of pro-inflammatory cytokines stimulated by LPS were down-regulated by TRAF1 ablation, along with the inactivation of nuclear factor κB (NF-κB). LPS-promoted reactive oxygen species (ROS) generation was decreased in TRAF1-KO mice, partly through the improvement of anti-oxidants. Apoptosis was also inhibited by TRAF1 deletion in lung tissues of LPS-challenged mice through the suppression of cleaved Caspase-3. Moreover, TRAF1 knockout significantly decreased c-Jun N-terminal kinase (JNK) activation and its down-streaming signal of c-Jun in pulmonary samples of LPS-induced mice. Importantly, the in vitro study suggested that promoting JNK activation markedly abrogated TRAF1 knockdown-attenuated inflammation, ROS production and apoptosis in LPS-exposed A549 cells. Therefore, our experimental results provided evidence that TRAF1 suppression effectively protected LPS-induced ALI against inflammation, oxidative stress and apoptosis through the suppression of JNK activity.

Finite element study of functionally graded porous femoral stems incorporating body-centered cubic structure.

The mismatch between stiffness of the femoral dense stem and host bone causes complications to patients, such as aseptic loosening and bone resorption. Three-dimensional finite-element models of homogeneous porous (HGP) and functionally graded porous (FGP) stems incorporating body-centered cubic (BCC) structures are proposed in this article as an alternative to the dense stems. The relationship between the porosity and strut thickness of the BCC structure was developed to construct the finite-element models. Three levels of porosities (20%, 50%, and 80%) were modeled in HGP and FGP stems. The porosity of the stems was decreased distally according to the sigmoid function (n = 0.1, n = 1 and n = 10) with 3 grading exponents. The results showed that FGP stems transferred 120%-170% higher stresses to the femur (Gruen zone 7) as compared to the solid stem. Conversely, the stresses in HGP and FGP stems were 12%-34% lower than the dense stem. The highest micromotions (105-147 µm) were observed for stems of 80% overall porosity, and the lowest (42-46 µm) was for stems of 20% overall porosity. Finally, FGP stems with a grading exponent of n = 10 resulted in an 11%-28% reduction in micromotions.

Coagulation Factor Activities Changes Over 5 Days in Thawed Fresh Frozen Plasma Stored at Different Initial Storage Temperatures.

Thawed plasma is fresh frozen plasma (FFP) that has been stored for 5 days at 1-6 °C. Duration of storage and different storage temperatures might affect the coagulation factor activity in thawed FFP. This study measured the changes of coagulation factor activities over 5 days in thawed FFP and stored at two different initial storage temperatures. Thirty-six units of FFP, which consisted of nine units each from blood groups A, B, AB, and O, were thawed at 37 °C. Each unit was divided into two separate groups (Group A and Group B) based on initial storage temperature. The first group was stored at 2-6 °C for 5 days (Group A). The second group was stored at 20-24 °C for initial 6 h followed by 2-6 °C for 5 days (Group B). Prothrombin time (PT), activated partial thromboplastin time (APTT), coagulation factor activities of fibrinogen, factor (F) II, FV, FVII, FVIII, FIX, FX, and von Willebrand factor antigen (vWF Ag) were assessed at baseline after thawing, at 6 h, and on days 1, 3, and 5 of storage for both groups. All coagulation factors mean activities in both storage groups decreased significantly over 5 days of storage. The mean FVIII activity at day 5 of storage was 36.9% in Group A and 39.8% in Group B. The other coagulation factors mean activities were > 50% on day 5 of storage in both groups. The coagulation factor activities of thawed FFP stored for 5 consecutive days were reduced in the two storage groups but most of the activities were still above 30%. This study suggests that thawed FFP stored for 5 days has the potential to ameliorate coagulation factor deficiencies in affected patients.

Patterns and trends in insulin initiation and intensification among patients with type 2 diabetes mellitus in the Western Pacific region.

OBJECTIVE: Current and future estimates of the burden of diabetes for the Western Pacific (WP) region are among the highest in the world. Verifying Insulin Strategy and Initial Health Outcome Analysis (VISION) was an 18 month observational study that explored treatment approaches in patients with type 2 diabetes mellitus (T2DM) initiating insulin in the WP region. METHODS: A total of 1065 patients aged ≥18 years with T2DM initiating insulin therapy in normal clinical course were enrolled from Hong Kong, Malaysia, Philippines, Taiwan and Thailand. Participants' data was recorded by the treating physicians. Patient-reported outcomes (PROs) were assessed using questionnaires completed by participants. RESULTS: The mean age of patients was 57.2 years with mean glycosylated hemoglobin (HbA1c) of 10.0%. About 66% of patients had an HbA1c ≥9.0% at insulin initiation despite 74% of them being on two or more oral antidiabetic agents at the time of insulin initiation. Basal insulin was initiated in 72% and premixed insulin in 27% of patients. Changes in insulin therapy was observed in 63% of patients and, by the end of study, 28% achieved HbA1c levels of <7.5%. The proportion of patients completely satisfied with their insulin treatment increased over the study course and the quality of life (QoL) score increased from baseline to the study end. CONCLUSION: As high HbA1C levels indicate a delayed start of insulin therapy, timely initiation and early intensification of insulin therapy is necessary in the region to achieve adequate glycemic control in time and prevent diabetes complications. Data from PROs suggests that the insulin treatment improves QoL in most patients.