A prediction model of elderly hip fracture mortality including preoperative red cell distribution width constructed based on the random survival forest (RSF) and Cox risk ratio regression.

An independent correlation between pre-RDW and 1-year mortality after surgery in elderly hip fracture can be used to predict mortality in elderly hip fracture patients and has predictive significance in anemia patients. With further research, a treatment algorithm can be developed to potentially identify patients at high risk of preoperative mortality. INTRODUCTION: Red blood cell distribution width (RDW) is an independent predictor of various disease states in elderly individuals, but its association with the prognosis of elderly hip fracture patients is controversial. This study aimed to evaluate the prognostic value of RDW in such patients, construct a prediction model containing RDW using random survival forest (RSF) and Cox regression analysis, and compare RDW in patients with and without anemia. METHODS: We retrospectively analyzed the data of elderly patients who underwent hip fracture surgery, selected the best variables using RSF, stratified the independent variables by Cox regression analysis, constructed a 1-year mortality prediction model of elderly hip fracture with RDW, and conducted internal validation and external validation. RESULTS: Two thousand one hundred six patients were included in this study. The RSF algorithm selects 12 important influencing factors, and Cox regression analysis showed that eight variables including preoperative RDW (pre-RDW) were independent risk factors for death within 1-year after hip fracture surgery in elderly patients. Stratified analysis showed that pre-RDW was still independently associated with 1-year mortality in the non-anemia group and not in the anemia group. The nomogram prediction model had high differentiation and fit, and the prediction model constructed by the total cohort of patients was also used for validation of patients in the anemia patients and obtained good clinical benefits. CONCLUSION: An independent correlation between pre-RDW and 1-year mortality after surgery in elderly hip fracture can be used to predict mortality in elderly hip fracture patients and has predictive significance in anemia patients.

Implementation of Evidence in Preventing Postoperative Sore Throat of Patients Undergoing General Anesthesia Intubation Using the i-PARIHS Framework.

Objective: The aim of the study was to assess the effectiveness of the implementation of the best evidence in preventing postoperative sore throat in patients undergoing general anesthesia intubation. Methods: The related topics of the postoperative sore throat of patients undergoing general anesthesia intubation were systematically searched in the database and evaluated using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Combined with clinical needs and evidence-based professional judgment, 20 pieces of evidence and 6 examination standards on the management process and evidence implementation plan for the prevention of postoperative sore throat in patients with general anesthesia intubation are summarized, implementing the best evidence into clinical practice in anesthesiology, general surgery, orthopedics, thoracic surgery, and gynecology. Results: Nurses' knowledge scores and evidence compliance significantly improved after the implementation of the best evidence (P < 0.05); the incidence of the postoperative sore throat in patients undergoing general anesthesia intubation decreased from 41.7% to 28.1%. Conclusion: The i-PARIHS framework effectively prevents postoperative sore throat in patients, providing an effective case for translating evidence into practice based on the i-PARIHS framework.

[Effects of simulated precipitation changes on plant community characteristics of wetland in the Yellow River Delta, China]. / 模拟降雨量变化对黄河三角洲湿地植物群落特征的影响.

Under the changing climate scenario, changes in precipitation regimes are expected to alter soil water and salinity conditions, with consequences on the characteristics of plant community in estuarine wetland. Here, we used a six-year (2015-2020) precipitation manipulation experiment to examine how plant community characteristics responded to precipitation changes in the Yellow River Delta. The results showed that soil electrical conductivity significantly decreased, while soil moisture significantly increased with increasing precipitation. Precipitation changes altered plant community composition. Increased precipitation reduced the absolute dominance of Suaeda glauca and Suaeda salsa, but increased that of Triarrhena sacchariflora and Imperata cylindrica. Shannon index and Margalef richness index of plant community significantly increased with increasing precipitation. Compared with the control, both decreased and increased precipitation decreased the plant community abundance, frequency and coverage. The treatment of 60% increased precipitation significantly decreased plant community frequency by 54.9%, while the 60% decreased precipitation, 40% decreased precipitation, 40% increased precipitation and 60% increased precipitation treatment significantly decreased plant abundance by 38.9%, 33.8%, 35.8% and 45.7%, respectively. The aboveground biomass significantly increased with increasing precipitation, but aboveground plant biomass under 60% increased precipitation treatment being lower than that reducing under 40% increased precipitation treatment, probably due to the negative effects of flooding stress. In addition, Margalef richness index had a significantly positive relationship with aboveground biomass. Aboveground biomass, Shannon diversity index, Margalef richness index, and Simpson diversity index were negatively related to soil electrical conductivity, and aboveground plant biomass was positively related to soil moisture. Our results revealed that precipitation changes regulate growth characteristics, species composition, and diversity of plant community by altering soil water and salinity conditions in a coastal wetland.

Peripherally inserted central catheter versus totally implanted venous port for delivering medium- to long-term chemotherapy: A cost-effectiveness analysis based on propensity score matching.

BACKGROUND: Peripherally inserted central catheters (PICCs) and totally implanted vascular access ports (PORTs) have been widely used for medium- to long-term chemotherapy. PICCs are associated with lower insertion cost, but higher complication rates than PORTs. However, there is a paucity of cost-effectiveness comparisons between the devices. We aimed to compare the cost-effectiveness of PICCs and PORTs for medium- to long-term chemotherapy from catheter insertion to removal. METHODS: A cost-effectiveness analysis was conducted based on propensity score matching (PSM) from the hospital perspective. Data were collected from a retrospective cohort study. The total cost outcome comprised insertion, maintenance, removal and complication costs. The effectiveness outcome was the complication-free rate. The primary and supplemental outcomes were cost-effectiveness ratios (CERs) and incremental cost-effectiveness ratios (ICERs). RESULTS: A total of 1050 patients (after PSM for 417 patients) were included. The average total cost for 3-6 month ($603.55 ± 78.68 vs $1270.21 ± 128.84), 6-9 month ($731.40 ± 42.97 vs $1414.48 ± 155.43), and 9-12 month ($966.83 ± 53.78 vs $1587.76 ± 160.56) dwell times were all significantly lower for PICCs than for PORTs (p < 0.001). PICCs were associated with significantly lower complication-free rates than PORTs during the 3-6 month (65.22% vs 90.58%, p < 0.001), 6-9 month (53.33% vs 91.80%, p < 0.001), and 9-12 month (44.44% vs 88.46%, p = 0.015) dwell times. Ultimately, PICCs were associated with lower CERs than PORTs for the 3-6 month (928.54 vs 1395.84) and 6-9 month (1380.00 vs 1537.48) but higher CER for the 9-12 month (2197.34 vs 1804.27) dwell times. ICERs were 2564.08 and 1751.49 with dwell times of 3-6 months and 6-9 months, respectively. CONCLUSION: This study provided economic evidence that informs vascular access device choice for medium- to long-term chemotherapy. For 3-9 month dwell times, PICCs were more cost-effective than PORTs. Furthermore, ICERs were applied and the choice was determined by willingness-to-pay. For 9-12 month dwell times, PORTs might be more cost-effective than PICCs, and studies with larger sample size would be needed to verify this finding in the future.

Protocol for the adaptation of clinical practice guidelines for the management of physical restraints in critically ill patients.

BACKGROUND: The effectiveness of physical restraints (PRs) in the prevention of unplanned extubation has been increasingly questioned, and several countries have developed clinical practice guidelines for reducing the use of PRs. However, some countries, including China, have failed to establish their guidelines, and the adaptation of existing guidelines to local circumstances may be an attractive alternative. METHODS: Following the guideline definition of Institute of Medicine, the guideline will be adapted following the CAN-IMPLEMENT©. Guideline scope and clinical questions will be established based on an integrative review, retrospective study, and stakeholder interviews. The guideline's quality will be assessed by the Appraisal of Guidelines for Research and Evaluation II and Appraisal of Guidelines Research and Evaluation-Recommendations Excellence. A systematic review and meta-analysis will be evaluated by A Measurement Tool to Assess Systematic Reviews. The guidelines will meet the criteria of the RIGHT-Ad@pt Checklist. DISCUSSION: This study describes the proposed protocol for adapting clinical practice guidelines on PRs in critically ill patients. We believe the guideline will help health professionals, especially critical care nurses, deliver safe, high-quality patient care by reducing the implementation of PRs in China. GUIDELINE REGISTRATION: The guideline has been registered at the International Practice Guidelines Registry Platform (http://www.guidelinesregistry.org/). The registration number is IPGRP-2019CN094, registration date 27-Dec-2019.

Economic evaluation of peripherally inserted central catheter and other venous access devices: A scoping review.

OBJECTIVE: With the widespread use of peripherally inserted central catheters, plenty of studies have compared peripherally inserted central catheters with other venous access devices to choose the most appropriate device in different clinical scenarios. Economic attributes are one of the important influencing factors in the selection of venous access devices. Several economic evaluation studies have been conducted in this area, but the evaluation methods, contents, outcomes, and quality of these economic studies have not been systematically evaluated. Therefore, we aimed to map the existing research on the economic evaluations of peripherally inserted central catheters and other venous access devices to provide economic evidence for decision-makers to choose a suitable venous access device. Second, we appraised the quality of economic evaluation studies in this area to highlight methodological weaknesses and provide an outline for the normative application of this methodology for future research. METHODS: A literature search was undertaken through 11 databases from inception until 11 March 2019, to identify economic evaluation studies comparing peripherally inserted central catheters with other venous access devices. After screening articles and extracting data independently, we summarized methods, contents, and outcomes of the included studies and appraised their methodological quality using the Joanna Briggs Institute critical appraisal checklist for economic evaluations. RESULTS: A total of 16 studies were included. Among the six studies comparing peripherally inserted central catheters with peripheral intravenous catheters, four studies performed a cost-effectiveness analysis and noted that peripherally inserted central catheters were more cost-effective than peripheral intravenous catheters. Two studies performed a cost analysis to compare peripherally inserted central catheters with peripheral intravenous catheters during the insertion and maintenance/removal periods but reached different conclusions. Seven of the included studies performed a cost analysis to compare peripherally inserted central catheters with central venous catheters. They pointed out that the catheter insertion costs of peripherally inserted central catheters were lower than those for central venous catheters in developed countries, whereas the opposite conclusion was reached in developing countries. Conversely, conclusions regarding the costs for catheter maintenance and catheter insertion and maintenance/removal were inconsistent. Six of the included studies performed a cost analysis to compare peripherally inserted central catheters with vascular access ports. They pointed out that the insertion costs of peripherally inserted central catheters were lower than those for vascular access ports, and the maintenance costs were higher than those for vascular access ports. Conversely, conclusions regarding the costs for catheter insertion and maintenance/removal were inconsistent. In addition, the methodological quality of the included studies had plenty of deficiencies, including no discounting, no sensitivity analysis, no incremental analysis, a lack of validity of costs and effectiveness, and so on. CONCLUSION: This scoping review highlighted the desperate paucity of economic evaluation studies of peripherally inserted central catheters and other venous access devices in amount, evaluation contents, and economic evaluation methods. The conclusions of the cost-effectiveness analysis of peripherally inserted central catheters with other venous access devices were consistent. Conversely, the conclusions of the cost analysis of peripherally inserted central catheters with other venous access devices were inconsistent mainly in the comparison of peripherally inserted central catheters with peripheral intravenous catheters, central venous catheters, and vascular access ports during the insertion and maintenance/removal periods. This review also highlighted many methodological issues of economic evaluations in this area. Therefore, it is necessary to conduct more high-quality economic evaluation studies on peripherally inserted central catheters and other venous access devices by performing cost-effectiveness analysis, cost-utility analysis, or cost-benefit analysis from catheter insertion to removal to provide evidence for clinical practitioners, patients, and decision-makers to choose a suitable venous access device in different clinical scenarios.

Quality appraisal of gestational diabetes mellitus guidelines with AGREE II: a systematic review.

BACKGROUND: Several societies and associations have produced and disseminated clinical practice guidelines (CPGs) for gestational diabetes mellitus (GDM). However, the quality of such guidelines has not been appraised so far. This study aims to evaluate the quality of CPGs for GDM published in the last decade using the AGREE II instrument. METHODS: A systematic search of the National Institute for Health and Care Excellence, New Zealand Guidelines Group, Scottish Intercollegiate Guidelines Network, Medlive, American Diabetes Association, Canadian Diabetes Association, International Diabetes Federation, as well as PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Chinese Periodical Database, and VIP Chinese Periodical Database was conducted from inception to June 2018. The quality was assessed by four trained researchers independently, using the AGREE IIinstrument. RESULTS: A total of 13 guidelines, published from 2009 to 2018, were finally included. Among them, 11 guidelines were evidence-based guidelines, and 2 were expert consensus. Scores for each of the six AGREE II domains(Median ± IQR) were 94 ± 11, 89 ± 53, 58 ± 37, 100 ± 6, 79 ± 48, 100 ± 71 and 67% ± 42%, and guidelines based on expert consensus generally scored lower than evidence-based guidelines (Z = -2.201, p = 0.028). Overall score of 10 guidelines were 5 points and above, and four guidelines were 7 points. Among six domains, two domains: Scope and Purpose, and Clarity of Presentation, had high scores; however, the domains of Rigor of Development, Stakeholder Involvement and Editorial Independence received lower scores. CONCLUSIONS: In general, the methodological quality of GDM guidelines is high, and evidence-based guidelines are superior to expert consensus. However, the domains of Rigor of Development, Stakeholder Involvement and Editorial Independence still need improvement. A systematic approach in the development of these guidelines and updating timely is needed. In some regions, more attention for guideline adaptation is recommended.

Effects of mechanical and chemical control on invasive Spartina alterniflora in the Yellow River Delta, China.

Spartina alterniflora is one of the most noxious invasive plants in China and many other regions. Exploring environmentally friendly, economic and effective techniques for controlling Spartina alterniflora is of great significance for the management of coastal wetlands. In the present study, different approaches, including mowing and waterlogging, mowing and tilling and herbicide application, were used to control Spartina alterniflora. The results suggest that the integrated approach of mowing and waterlogging could eradicate Spartina alterniflora, the herbicide haloxyfop-r-methyl could kill almost all the Spartina alterniflora, and the integrated approach of mowing and tilling at the end of the growing season was a perfect way to inhibit the germination of Spartina alterniflora in the following year. However, no matter which control approach is adopted, secondary invasion of Spartina alterniflora must be avoided. Otherwise, all the efforts will be wasted in a few years.

Current guidelines on the management of gestational diabetes mellitus: a content analysis and appraisal.

BACKGROUND: Despite many guidelines for the management of gestational diabetes available internationally, little work has been done to summarize and assess the content of existing guidelines. A paucity of analysis guidelines within in a unified system may be one explanatory factor. So this study aims to analyze and evaluate the contents of all available guidelines for the management of gestational diabetes. METHOD: Relevant clinical guidelines were collected through a search of relevant guideline websites and databases (PubMed, Web of Science, Embase, etc.). Fourteen guidelines were identified, and each guideline was assessed for quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Two independent reviewers extracted guideline recommendations using a "recommendation matrix" through which basic guideline information and consistency between search strategy and selection of evidence, between selected evidence and interpretation, and between interpretation and resulting recommendations were analyzed. RESULTS: Fourteen documents were analyzed, and a total of 361 original recommendations for gestational diabetes mellitus (GDM) management were assessed. In all guidelines included, the recommendations were developed in five domains, namely, diagnosis of GDM, prenatal care, intrapartum care, neonatal care and postpartum care. Different guidelines appeared to have significant discrepancy in consistency of guideline content, but overall, there was consistency between search strategy and selection of evidence, between selected evidence and interpretation, and between interpretation and resulting recommendations (scilicet 49.31, 57.20 and 58.17%, respectively). CONCLUSION: Although commonality in most recommendations existed, there were still some discrepancies between guidelines. Consistency of guidelines on the management of GDM in pregnancy is highly variable and needs to be improved.

Improving Evidence Dissemination and Accessibility through a Mobile-based Resource Platform.

Current mobile information technologies fundamentally influence evidence dissemination from the perspective of both evidence seekers and evidence providers. However, there is no related study which tried using a mobile-based platform to disseminate evidence in China. The main object of this study is to develop a mobile-based evidence resource platform and to evaluate its effects of improving nurses' access to evidence-based practice resources and meeting users' demands. The mobile-based evidence resource platform was developed in 2014. A cross-sectional study was conducted over a period of 2 months between December 2015 and January 2016 to evaluate user experiences of and preferences regarding the platform. Descriptive analysis was adopted to analyze information and its communication effects from December 2014 to March 2017. A total of 472 participants met the inclusion criteria and responded to the survey. High scores were received for the overall rating (4.34 ± 0.67), evidence section (4.30 ± 0.63), learning materials section (4.26 ± 0.65), news section (4.27 ± 0.66), readability (4.38 ± 0.63), design and structure (4.38 ± 0.63), and interactivity (3.58 ± 0.84). As of March 31, 2017, the total number of followers was 28,954. The total number of readings was 584,834. The most current WCI value was 388.72. Our study demonstrated that the mobile-based platform for evidence transfer can promote the accessibility of evidence and meet users' demands. This mobile-based platform is currently available in the WeChat application environment. It will be a wise option for healthcare professionals for the purposes of learning about EBP and disseminating evidence in China.

Validation of the Simplified Chinese Version of the Memorial Symptom Assessment Scale-Short Form Among Cancer Patients.

CONTEXT: Comprehensive symptom assessment is crucial for symptom management. The Memorial Symptom Assessment Scale-Short Form (MSAS-SF) has been validated for symptom assessment in cancer patients, but there is no simplified Chinese version. OBJECTIVES: To present the validation procedures and results for the simplified Chinese version of the Memorial Symptom Assessment Scale-Short Form (MSAS-SF-SC) among cancer patients in mainland China. METHODS: The MSAS-SF was translated and culturally adapted into simplified Chinese. About 359 cancer patients completed the MSAS-SF-SC, the Chinese Functional Assessment of Cancer Therapy-General, the Chinese Brief Fatigue Inventory, the Chinese Hospital Anxiety and Depression Scale, and the Chinese Medical Outcomes Study Social Support Survey. Reliability was assessed by internal consistency and test-retest coefficients. Convergent and divergent validity were analyzed by Pearson's correlation coefficients between MSAS-SF-SC subscales and the other instruments. Known-groups validity used Eastern Cooperative Oncology Group-Performance Status, hemoglobin level, and primary site. RESULTS: The MSAS-SF-SC was reliable with Cronbach's alpha coefficients for subscales ranging from 0.782 to 0.874 and test-retest coefficients ranging from 0.819 to 0.872. MSAS-SF-SC subscales correlated with corresponding Chinese Functional Assessment of Cancer Therapy-General subscales (-0.557 to -0.680; P < 0.001), Chinese Brief Fatigue Inventory (0.620; P < 0.001), and Chinese Hospital Anxiety and Depression Scale (0.663; P < 0.001) indicating convergent validity. MSAS-SF-SC subscales showed low or no correlations with the Chinese Medical Outcomes Study Social Support Survey (-0.146 to -0.165; P < 0.01), indicating divergent validity. MSAS-SF-SC subscales showed appropriate differences by Eastern Cooperative Oncology Group-Performance Status, hemoglobin level, and primary site. CONCLUSION: The MSAS-SF-SC demonstrated good psychometric properties and is culturally adapted. The instrument could be a valuable tool for Chinese health care professionals and researchers.

Lipoxin A4 protects against spinal cord injury via regulating Akt/nuclear factor (erythroid-derived 2)-like 2/heme oxygenase-1 signaling.

Spinal cord injury (SCI) is a devastating physical trauma worldwide. The mechanisms of SCI are still not clear and the effective treatment is limited. Lipoxin A4 (LXA4) possesses anti-inflammatory and neuroprotective effects. The present study was designed to further evaluate the molecular mechanisms of LXA4-induced protective effects in a rat model of SCI. We found that LXA4 increased Basso, Beattie and Bresnahan (BBB) scores, increased mechanical paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) to a radiant heat, reduced the lesion volume, decreased Bax mRNA expression and increased Bcl-2 expression after SCI. The phosphorylation of Akt and protein expression of Nrf2 and HO-1 were reduced after SCI. LXA4 treatment significantly inhibited the reduction of Akt phosphorylation and Nrf2 and HO-1 protein expression. Injection of LY294002 notably inhibited the phosphorylation of Akt, and the expression of total Akt and Nrf2 and HO-1 after SCI in LXA4-treated rats. LY294002 prohibited LXA4-induced effects after SCI. shNrf2 injection markedly decreased both Nrf2 and HO-1 expression in LXA4-treated rats after SCI. ZnPP notably decreased HO-1 expression but did not markedly affect Nrf2 expression. shNrf2 and ZnPP prohibited LXA4-induced increase of BBB scores, and PWT and PWL, decrease of lesion volume of spinal cord, reduction of Bax expression and increase of Bcl-2 expression. The results indicate that LXA4 protects against SCI through Akt/Nrf2/HO-1 signaling. The data provide novel insights into the mechanisms of LXA4-mediated neuprotective effects against SCI and suggest that LXA4 may be a potential therapeutic agent for SCI and its associated complications.

Costunolide, an active sesquiterpene lactone, induced apoptosis via ROS-mediated ER stress and JNK pathway in human U2OS cells.

Costunolide, an active sesquiterpene lactone, is derived from many herbal medicines and it exhibits a broad spectrum of bioactivities such as anti-inflammatory, potential anti-tumor activity. Herein we assessed the anti-cancer effects of costunolide on U2OS cells and explored the underlying molecular mechanisms. The experiment data show that Costunolide exhibited significant anti-tumor activity by apoptosis related assays including Annexin V-FITC/PI flow cytometric analysis and 4,6-diamino-2-phenyl indole (DAPI) staining morphological analysis. Furthermore, we found Costunolide induced the loss of mitochondrial transmembrane potential, down-regulated Bcl-2/Bax ratio, encouraged Cyt-c release and caspase activation. All those effects are contributed by reactive oxygen species (ROS) generation and ER stress-induced mitochondrial dysfunction which are also responsible for c-Jun N-terminal kinase (JNK) activation. After the treatment of JNK inhibitor SP600125, it obviously reversed costunolide-induced apoptosis. Given N-acetyl-l-cysteine (NAC) effectively blocked the activation of JNK. Taken together, our results demonstrate that costunolide induces apoptosis in human U2OS cells through ROS generation and p38 MAPK/JNK activation.

Detection of the SHV genotype polymorphism of the extended-spectrum ß-lactamase-producing Gram-negative bacterium.

The prevalence of extended-spectrum ß-lactamases (ESBLs) is due to the extensive usage of the extended-spectrum cephalosporins and leads to huge financial loss worldwide, whilst presenting a challenge to the clinical treatment. The aim of the present study was to delineate the frequency of ESBL occurrence in Enterobacteriaceae and confirm the SHV genotype. A random collection of 153 Escherichia coli isolates (E. coli) and 70 Klebsiella pneumoniae isolates were tested. The amplification products obtained by polymerase chain reaction were sequenced. Isolates with novel mutations were transformed to E. coli DH5 α. The minimum inhibitory concentration (MIC) was obtained by a microdilution method. The relevance ratio of ESBL was 67.7% and the proportion of the SHV ß-lactamase gene (blaSHV) was 18.5%. A new genotype of ß-lactamase was demonstrated and submitted to GenBank. A total of 12 mutational sites were found in 28 ESBL-producing isolates, including four nonsense mutations. Sensitive-rates of 28 ESBL-producing isolates to imipenem were 100%, and resistant-rates to penicillin, amoxicillin and oxacillin were 100%. The MIC of DH5 α-F8 to penicillin, oxacillin, cefoxitin, cefotaxime, cefepime, cefoperazone/sulbactam, imipenem and netilmicin was 512, 512, 2, 0.03, 0.06, 4, 0.015 and 32 respectively. In conclusion, ESBL and SHV-28 is the most prevalent bla. Imipenem is the most effective antibiotic to ESBL, and the 4th-generation cephalosporins and ß-lactamase inhibitor compound are also effective. ESBL is mediated by plasmids and able to spread among different Enterobacteriaceae. In conclusion, new mutations of the blaSHV gene exist from at least 2010.

Effects of thermotherapy on Th1/Th2 cells in esophageal cancer patients treated with radiotherapy.

BACKGROUND: To investigate the effects of double radiofrequency hyperthermia on Th1/Th2 cells in esophageal cancer patients treated with radiotherapy. MATERIALS AND METHODS: 22 patients with esophageal cancer were divided into a radiotherapy group (10 cases) and a combined group (double radiofrequency hyperthermia combined with radiotherapy group, 12 cases). Both groups received conventional radiotherapy using a cobalt-60 therapy apparatus (TD60-66Gy/30-33F). Patients in the combined group also underwent double radiofrequency hyperthermia (2F/W, 8-10F). Before and after treatment, Th1, Th2, Tc1 and Tc2 cells in peripheral blood were determined with flow cytometry. RESULTS: In the radiotherapy group, Th1 cell contents before and after radiotherapy were 17.5 ± 5.26% and 9.69 ± 4.86%, respectively, with a significant difference (p<0.01). The Th1/Th2 ratio was significantly decreased from 28.2 ± 14.3 to 16.5 ± 10.4 (p<0.01). In the combined group, Th1 cell content before radiotherapy was 15.9 ± 8.18%, and it increased to 18.6 ± 8.84 after radiotherapy (p>0.05), the Th1/Th2 ratio decreasing from 38.4 ± 36.3 to 28.1 ± 24.0 (p>0.05). Changes in Th2, Tc1 and Tc2 cell levels were not significant in the two groups before and after therapy (p>0.05). CONCLUSIONS: Double radiofrequency hyperthermia can promote the conversion from Th2 to Th1 cells, and regulate the balance of Th1/Th2 cells.

Effects of quercetin on the proliferation of breast cancer cells and expression of survivin in vitro.

Quercetin is a hydrophobic agent with potential anticancer activity. The aim of the present study was to observe the effects of quercetin on the proliferation of the breast cancer cell line MCF-7 and the gene expression of survivin. The molecular mechanism underlying the antiproliferative effect of quercetin was also investigated. MCF-7 breast cancer cells were treated with various concentrations of quercetin. The inhibitory effect of quercetin on proliferation was detected using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method and the inhibition rate was calculated. Cellular apoptosis was detected by immunocytochemistry and survivin mRNA expression levels were observed using reverse transcription-polymerase chain reaction (RT-PCR). Western blot analysis was used to analyze changes in the expression levels of survivin protein. Quercetin induced the apoptosis of MCF-7 cells and inhibited the proliferation of the MCF-7 breast cancer cells in a time- and concentration-dependent manner. The mRNA and protein expression levels of survivin were reduced as the concentration of quercetin increased. Quercetin inhibited the growth of MCF-7 cells and promoted apoptosis by inducing G0/ G1 phase arrest. It also regulated the expression of survivin mRNA in MCF-7 cells, which may be the mechanism underlying its antitumor effect.

Inhibitory effect of saponins and polysaccharides from Radix ranunculi ternati on human gastric cancer BGC823 cells.

The effects of different Radix ranunculi ternati extracts on human gastric cancer BGC823 cells were investigated, different methods were used to extract the saponins and polysaccharides from Radix ranunculi ternati, and MTT assay and colony formation assay were used to observe the effects of saponins and polysaccharides from Radix ranunculi ternati on in-vitro cultured human gastric cancer BGC823 cells. The results found that the saponins and polysaccharides from Radix Ranunculi Ternati had certain effects on both the growth and colony formation of human gastric cancer BGC823 cells, while improving the immune function of normal mice, of which saponins had more significant effects than polysaccharides.

Anticancer effect and mechanism of polymer micelle-encapsulated quercetin on ovarian cancer.

Encapsulation of hydrophobic agents in polymer micelles can improve the water solubility of cargos, contributing to develop novel drugs. Quercetin (QU) is a hydrophobic agent with potential anticancer activity. In this work, we encapsulated QU into biodegradable monomethoxy poly(ethylene glycol)-poly(ε-caprolactone) (MPEG-PCL) micelles and tried to provide proof-of-principle for treating ovarian cancer with this nano-formulation of quercetin. These QU loaded MPEG-PCL (QU/MPEG-PCL) micelles with drug loading of 6.9% had a mean particle size of 36 nm, rendering the complete dispersion of quercetin in water. QU inhibited the growth of A2780S ovarian cancer cells on a dose dependent manner in vitro. Intravenous administration of QU/MPEG-PCL micelles significantly suppressed the growth of established xenograft A2780S ovarian tumors through causing cancer cell apoptosis and inhibiting angiogenesis in vivo. Furthermore, the anticancer activity of quercetin on ovarian cancer cells was studied in vitro. Quercetin treatment induced the apoptosis of A2780S cells associated with activating caspase-3 and caspase-9. MCL-1 downregulation, Bcl-2 downregulation, Bax upregulation and mitochondrial transmembrane potential change were observed, suggesting that quercetin may induce apoptosis of A2780S cells through the mitochondrial apoptotic pathway. Otherwise, quercetin treatment decreased phosphorylated p44/42 mitogen-activated protein kinase and phosphorylated Akt, contributing to inhibition of A2780S cell proliferation. Our data suggested that QU/MPEG-PCL micelles were a novel nano-formulation of quercetin with a potential clinical application in ovarian cancer therapy.

Association between polymorphisms of ERCC1 and XPD and clinical response to platinum-based chemotherapy in advanced non-small cell lung cancer.

BACKGROUND AND OBJECTIVE: DNA repair capacity is correlated with sensitivity of cancer cells toward platinum-based chemotherapy. The aim of this study was to investigate whether single nucleotide polymorphisms (SNPs) in polymorphisms of DNA repair gene ERCC1 (excision repair cross-complementation group 1) and XPD (ERCC2, excision repair cross-complementation group 2) were associated with the tumor response in advanced non-small-cell lung cancer (NSCLC) patients received platinum-based chemotherapy in Chinese population. METHODS: Totally 115 patients with advanced NSCLC were routinely treated with cisplatin- or carboplatin-based chemotherapy, and clinical response was evaluated after 2 cycles. Three dimensions (3-D) polyacrylamide gel-based DNA microarray method was used to evaluate the genotypes of ERCC1 Asn118Asn (354 CT), Gln504Lys (8092 CA) and XPD Lys751Gln (35931 AC). RESULTS: The C→T change of ERCC1 Asn118Asn polymorphism and the C→A change of ERCC1 Gln504Lys polymorphism have statistically significant association with elevated or descendent platinum-based chemotherapy response respectively. CONCLUSION: The polymorphic status of ERCC1 might be the promising ancillary marker for predicting treatment response of advanced stage NSCLC patients. The DNA microarray-based method is accurate, high-throughput and inexpensive, suitable for SNP genotyping in a large number of individuals.

XPA A23G polymorphism is associated with the elevated response to platinum-based chemotherapy in advanced non-small cell lung cancer.

DNA repair capacity (DRC) is correlated with sensitivity of cancer cells toward platinum-based chemotherapy. We hypothesize that genetic polymorphisms in DNA repair gene XPA (xeroderma pigmentosum group A) and XPG (xeroderma pigmentosum group G) (ERCC5, excision repair cross-complementation group 5), which result in inter-individual differences in DNA repair efficiency, may predict clinical response to platinum agents in advanced non-small cell lung cancer (NSCLC) patients. In this study, we find that the Aright curved arrow G change of XPA A23G polymorphism significantly increased response to platinum-based chemotherapy. Polymorphism in XPG His46His was associated with a decreased treatment response, but was not statistically significant.