BACKGROUND: This study aimed to investigate the prevalence rate of critical illness-related corticosteroid insufficiency (CIRCI) and the effect of low-dose glucocorticoid on prognosis of CIRCI in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: Since January 2010 to December 2012, 385 patients, who met the criteria of AECOPD, were enrolled in the Intensive Care Unit (ICU) of the First People's Hospital and Municipal Central Hospital of Xiangtan City. The AECOPD patients complicated with CIRCI screened by an adrenalcorticotrophic hormone test within 12 hours after admission to ICU were divided into a treatment group (n=32) and a control group (n=31) for a prospective, randomized and controlled clinical trial. Hydrocortisone (150 mg/d) or normal saline was injected intravenously for 7 days. The patients were followed up for 28 days after injection. The endpoint included 28-day survival time, non-shock time, ICU stay and the period of non-mechanical ventilation. The markers of inflammation C-reactive protein, tumor necrosis factor-α, interleukin 6 and procalcitonin were measured at baseline and 7 days after treatment. The variables were analyzed by Student's t test, the non-parametric statistical test, the Chi-square test or the Kaplan-Meier method with SPSS18.0 statistic software. A P value <0.05 was considered statistically significant. RESULTS: Totally 63 patients were diagnosed with CIRCI by an adrenalcorticotrophic hormone test and the prevalence rate was 16.4％. The shock rate of the AECOPD patients complicated with CIRCI was higher than that of the AECOPD patients without CIRCI (23.8％ vs. 8.7％, P<0.01). Kaplan-Meier analysis revealed that the 28-day survival time of the treatment group was obviously longer than that of the control group (P<0.05). Compared with the control group, shock-free days within 28 days was longer in the treatment group (18.2±9.5 vs. 25.8±4.1, P<0.05). Treatment with low-dose glucocorticoid obviously decreased the markers of infection and inflammation (P<0.01), such as C-reactive protein (13.2±5.5 mg/L vs. 8.3±3.1 mg/L for the control group; 13.5±5.9 mg/L vs. 5.1±2.3 mg/L for the treatment group), tumor necrosis factor-α (26.1±16.2 g/L vs. 17.5±11.7 g/L for the control group; 25.0±14.8 g/L vs. 10.4±7.8 g/L for the treatment group) and procalcitonin (3.88 g/L vs. 2.03 g/L for the control group; 3.77 g/L vs. 1.26 g/L for the treatment group). Furthermore, the markers in the treatment group decreased more obviously than those in the control group (P<0.01). CONCLUSION: The prevalence rate of CIRCI was higher in the patients with AECOPD in the department of critical medicine, and low-dose glucocorticoid treatment for one week reduced the 28-day mortality, shock time and markers of infection and inflammation.

Reduced radiosensitivity of lung cancer cells represents a pivotal obstacle in clinical oncology. The hypoxia-inducible factor (HIF)-1α plays a crucial role in radiosensitivity, but the detailed mechanisms remain elusive. A relationship has been suggested to exist between hypoxia and autophagy recently. In the current study, we studied the effect of hypoxia-induced autophagy on radioresistance in lung cancer cell lines. A549 and H1299 cells were cultured under normoxia or hypoxia, followed by irradiation at dosage ranging from 0 to 8 Gy. Clonogenic assay was performed to calculate surviving fraction. EGFP-LC3 plasmid was stably transfected into cells to monitor autophagic processes. Western blotting was used to evaluate the protein expression levels of HIF-1α, c-Jun, phosphorylated c-Jun, Beclin 1, LC3 and p62. The mRNA levels of Beclin 1 were detected by qRT-PCR. We found that under hypoxia, both A549 and H1299 cells were radio-resistant compared with normoxia. Hypoxia-induced elevated HIF-1α protein expression preferentially triggered autophagy, accompanied by LC3 induction, EGFP-LC3 puncta and p62 degradation. In the meantime, HIF-1α increased downstream c-Jun phosphorylation, which in turn upregulated Beclin 1 mRNA and protein expression. The upregulation of Beclin 1 expression, instead of HIF-1α, could be blocked by SP600125 (a specific inhibitor of c-Jun NH2-terminal kinase), followed by suppression of autophagy. Under hypoxia, combined treatment of irradiation and chloroquine (a potent autophagy inhibitor) significantly decreased the survival potential of lung cancer cells in vitro and in vivo. In conclusion, hypoxia-induced autophagy through evaluating Beclin1 expression may be considered as a target to reverse the radioresistance in cancer cells.

ObjectiveTo explore the effect of Qingfei Jiangmai decoction （QJD） on the content of mercapturic acids in urine in healthy people amid PM_2.5 （particles 2.5 microns or less in size） pollution. MethodA total of 84 healthy students of 18-30 years old in Beijing were recruited and they were randomized into the test group （42 in total， with 1 dropout） and control group （42 in total， with 3 dropouts）. During the pollution， the test group and the control group respectively took QJD granules and placebo for 7 days （1 bag/time， 2 times/day）， and another 7-day intervention with the same drugs was performed at an interval of 4 weeks. The time-activity patterns were recorded during the intervention. On-line solid phase extraction-liquid chromatography/tandem mass spectrometry （SPE-LC-MS/MS） was performed to detect the content of PM_2.5-related metabolites S-phenylmercapturic acid （SPMA）， 3-hydroxypropylmercapturic acid （3-HPMA）， 3-hydroxy-1-methylpropylmercapturic acid （HMPMA）， N-acetyl-S-（2-nitrile ethyl）-L-cysteine （CEMA）， and N-acetyl-S-（2-hydroxy ethyl）-L-cysteine （HEMA） in urine before and after intervention. Statistical analysis was followed. ResultThe content of CEMA， HEMA， 3-HPMA， and HMPMA in the test group was all higher after the intervention than before the intervention， with the significant difference in HEMA （P<0.05）. After intervention， content of HEMA and SPMA was significantly higher in the test group than in the control group （P<0.05）， and the difference in HEMA （Z=-3.614， P<0.01） and HMPMA （Z=-1.988， P<0.05） before and after invention in the test group was significantly larger than that in the control group. After the intervention， HEMA in the test group was significantly higher than that in the control group （F=7.597， P<0.01）. ConclusionDuring PM_2.5 pollution， QJD can increase the excretion of HEMA， a metabolite of ethylene oxide， in the urine of healthy people in Beijing， and enhance the detoxification process of toxic components in PM_2.5， which is of great value in preventing and treating haze-related illnesses.

Adult ; Female ; Fetofetal Transfusion ; surgery ; Fetoscopy ; methods ; Humans ; Pregnancy ; Pregnancy Complications ; surgery ; Pregnancy Reduction, Multifetal ; methods ; Pregnancy, Multiple ; Treatment Outcome ; Young Adult

In this study,we aimed to study the pattern visual evoked potentials (P-VEPs) in two eyes with varying visual acuity in one eye and to provide an objective estimation of visual acuity by comparing P-VEPs in one and two eyes.Thirty subjects were chosen,who had one eye with an acuity of 5.0,4.85,4.6,4.0,or scieropia and obstructed vision and the other eye with an acuity of 5.0,respectively.P-VEPs were detected under the large grating stimuli at 3×4 spatial frequency,moderate grating stimuli (12× 16 spatial frequency) and small grating stimuli (48×64 spatial frequency).Under large grating stimuli,there was no significant difference in P100 peak latency between the groups,nor was there a significant difference between the amplitude of two eyes and the amplitude of one normal-vision eye.Under moderate and small grating stimuli,there was a significant difference in P100 peak latency between the group with both eyes having an acuity of 5.0 and the group with visual acuity below 4.0 in one eye.There was a significant difference in P100 amplitude between the group with visual acuity of 5.0 in both eyes and the group with one normal-vision eye.There was no significant difference in the amplitude of two eyes and the amplitude of one normal-vision eye between any other two groups.In forensic identification,characteristics and variability of P-VEPs in one and two eyes can be used to identify malingering or decline in visual acuity.

OBJECTIVETo investigate the changes of thyroxin and monocyte human leukocyte antigen-DR expression in senior patients with sepsis and explore their clinical significance.

METHODSAccording to the 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions, 125 senior patients with sepsis free of thyroid conditions were divided into non-severe sepsis group (n=86) and severe sepsis group (n=39), with another 30 healthy subjects as the control. Thyroid function was assayed by chemoluminescence method in these patients and monocyte HLA-DR expression was determined by flow cytometry.

RESULTSCompared with the control group and non-severe sepsis cases, the levels of free T3 (FT3), free T4 (FT4), T3, T4 and monocyte HLA-DR expression were significantly lower in severe sepsis cases (P<0.05), but the levels of thyroid stimulating hormone (TSH) were comparable between the 3 groups (P>0.05). The non-severe sepsis cases showed significantly lower levels of FT3, FT4, T3, T4, TSH and monocyte HLA-DR expression than the control group (P<0.05). In severe sepsis group, the levels of FT3, FT4, T3, T4 and monocyte HLA-DR expression showed significant differences between the fatal cases and surviving cases (P<0.05).

CONCLUSIONThe levels of thyroxin and monocyte human leukocyte antigen-DR expression are obviously lower in senior patients with severe sepsis, and their detection may well indicate the severity of the condition and help make prognostic judgment.

Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; HLA-DR Antigens ; blood ; immunology ; Humans ; Male ; Monocytes ; metabolism ; Pneumonia ; complications ; Sepsis ; blood ; etiology ; immunology ; Thyrotropin ; blood ; Thyroxine ; blood ; Triiodothyronine ; blood

BACKGROUNDThe benefit of neoadjuvant chemotherapy in the management of head and neck squamous cell carcinomas (HNSCC) still remains controversial. The aim of this meta-analysis is to evaluate the role of the neoadjuvant chemotherapy with the cisplatin and fluororacil (PF) regimen in enhancing the overall survival of and decreasing locoregional relapse and distant metastasis in HNSCC patients.

METHODSMedline and manual searches were performed to identify all published randomized controlled trials (RCTs) investigating the efficacy of the neoadjuvant chemotherapy with the PF regimen. Outcomes assessed by meta-analysis included locoregional relapse, distant metastasis, and overall survival. The odds ratio was the principle measurement of effect, which was calculated as the treatment group (chemotherapy plus locoregional treatment) versus the control group (locoregional treatment alone) and was presented as a point estimate with 95% confidence intervals (CI).

RESULTSEight RCTs were adopted for analysis. The meta-analysis showed that the odds ratio for the locoregional relapse was 0.92 (0.70 - 1.22, 95% CI), which was not statistically significant. The odds ratios for distant metastasis and overall survival were 0.47 (0.33 - 0.68, 95% CI) and 1.28 (1.01 - 1.62, 95% CI) respectively, which were both statistically significant.

CONCLUSIONSNeoadjuvant chemotherapy with the PF regimen in HNSCC patients has no effect on locoregional relapse. However, it shows a small but significant benefit in reducing distant metastasis and improving the overall survival.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; mortality ; Chemotherapy, Adjuvant ; Cisplatin ; administration & dosage ; Fluorouracil ; administration & dosage ; Head and Neck Neoplasms ; drug therapy ; mortality ; Humans ; Neoadjuvant Therapy ; Randomized Controlled Trials as Topic

Objective To explore the correlation of serum matrix metalloproteinase-2 (MMP-2) and tissue metalloproteinase inhibitor-2 (TIMP-2) levels to carotid atherosclerosis plaque vulnerability in patients with anterior circulation infarction. Methods Sixty patients with anterior circulation infarction and 38 healthy volunteers were enrolled in this study. Color Doppler ultrasonography of the carotid artery was performed to determine the carotid intima-media thickness (IMT), Crouse plaque integral (CPI) score, and the total carotid plaque area (CPA). According to the nature of the carotid atherosclerosis plaque defined by ultrasonography, the patients were divided into vulnerable plaque (VP) group (33 cases), stable plaque (SP) group (27 cases), and no plaque (NP) group (38 cases). Serum MMP-2 and TIMP-2 levels were detected in these subjects using enzyme-linked immnosorbent assay (ELISA). Results Ultrasonography showed significantly greater/MT, CPI and CPA in VP group than in SP and NP groups (P<0.05). Serum MMP-2 level was significantly elevated in VP group as compared with that in SP and NP groups (P<0.05). Serum TIMP-2 level was significantly lower in VP group than in SP and NP groups (P<0.05). In VP group, serum MMP-2 level and MMP-2/TIMP-2 ratio were found to positively correlate to IMT, CPl and CPA (r=0.961, 0.966, and 0.804 for MMP-2, respectively, P<0.05;r=0.625, 0.709, and 0.651 for MMP-2/TIMP-2 ratio, respectively, P<0.05), while TIMP-2 was inversely correlated to IMT, CPI and CPA (r=-0.944, -0.996, and -0.859, respectively, P<0.05). Conclusion Serum MMP-2 and TIMP-2 levels and MMP-2/TIMP-2 ratio are closely correlated to carotid atherosclerosis plaque vulnerability.

Objective To investigate the protective effect of gypenoside (GP) on oxidative damage of the white matter in rats after chronic cerebral hypoperfusion and on its alterations of cognitive function.Methods A total of 57 male SD rats were randomly assigned to 4 groups:sham-operated group (n=12),vehicle group (n=15),200 mg/kg GP treatment group (n=15) and 400 mg/kg GP treatment group (n=15); chronic cerebral hypo-peffused models in the later 3 groups were established by permanent bilateral common carotid artery occlusion (2-VO).The dosage volume of all groups was 10 mL/kg; 3 h after the surgery,all rats orally received the initial administration of 400 mg/kg or 200 mg/kg GP dissolved in saline solution or matched volume of normal saline daily for a consecutive 33 d according to the above-mentioned experimental plan.Spatial learning and memory were assessed using Morris water maze test.Following behavioral tests,the activities of superoxide dismutase (SOD) and changes of malondialdehyde (MDA) level in the corpus callosum and optic tracts were measured by ELISA.The oxidative central nerve cell damages were assessed by immunohistochemical staining for 8-hydroxy-2'-deoxyguanosine (8-OHdG).Results Rats of the 400 mg/kg GP treatment group spent significantly fewer time in finding the platform,but significantly longer time spending in the platform region as compared with those of the vehicle group (P＜0.05).As compared with those in rats of the sham-operated group,the SOD activity was markedly reduced and MDA content was significantly increased in rats of the vehicle group (P＜0.05).Rats of the 400 mg/kg GP treatment group had decreased MDA content,increased SOD activity and decreased 8-OHdG level as compared with rats of the vehicle group (P＜0.05); however,200 mg/kg GP treatment group had no such significant effects as compared with those of the vehicle group (P＞0.05).Conclusion GP can ameliorate the oxidative damage in the corpus callosum and optic tract of rats after chronic cerebral hypoperfusion,indicating that GP may have therapeutic potential for treating dementia induced by chronic cerebral hypoperfusion; however,the related mechanisms for its alteration of cognitive function needs further research.

OBJECTIVETo characterize the different varieties of Pseudostellaria heterophylla during cultivation.

METHODUsing systematic selection in the main productive areas, the techniques of random design, all varieties were observed for 3 years.

RESULTThe biological and 425 productive characteristics of P. heterophylla var. macrophylla, P. heterophylla var. Foliolum, and P. heterophylla var. anvense were significantly different (P < 0.01). There were also differences in ecological adaptability, plant characteristics, pollen granule, chromosomes, and isoenzyme of the three cultivars.

CONCLUSIONThe strain types of P. heterophylla was denominated for the first time. The characteristics and productivity index system of P. heterophylla varieties were determined.

Caryophyllaceae ; anatomy & histology ; enzymology ; genetics ; Catechol Oxidase ; analysis ; Chromosomes, Plant ; Ecosystem ; Flowers ; anatomy & histology ; Lipase ; analysis ; Peroxidase ; analysis ; Plant Leaves ; anatomy & histology ; Plant Roots ; anatomy & histology ; Plants, Medicinal ; anatomy & histology ; enzymology ; genetics