BACKGROUND: Previous studies have shown that stress response can cause immune dysfunction in the body. T cell immunoglobulin and ITIM domain (TIGIT) is an immunoregulatory receptor that can inhibit T cell activity, promote T cell apoptosis and promote T cell subgroup distribution imbalance. Whether the immune response mechanism of stress response is related to the expression and function of TIGIT is still unclear. OJECTIVE: To investigate the expression of immunomodulatory receptor TIGIT in thymus cells and peripheral blood mononuclear cells in an anger rat model and its significance to immune function. METHODS: Forty-eight Wistar male rats were randomly divided into normal group, 7-, 14-and 21-day model groups, with 12 rats in each group. In addition to the blank group, social isolation method with plantar electric shock method was used to establish rat anger models in the other groups. The behavioral changes of rats were observed by open-field test and aggressive behavior test, and the changes in body mass and thymus index before and after the test were recorded. The positive expression of TIGIT in thymus and peripheral blood mononuclear cells of rats in each group was observed by immunohistochemistry, and the expression levels of CD4+ and CD8+ T cells in the peripheral blood were measured by flow cytometry. The correlation between TIGIT expression in thymus and peripheral blood mononuclear cells and the CD4+/CD8+ ratio of T cell subsets in the peripheral blood was analyzed. An ethical approval for the study was obtained from the Animal Ethics Committee of Jiangxi University of Traditional Chinese Medicine. RESULTS AND CONCLUSION: In the 14-and 21-day model groups, the scores of horizontal and vertical activities in the open-field test of rats were higher than the control group (P < 0.05 or P < 0.01). In the 7-, 14-and 21-day model groups, the attack hiding time of the attack behavior test was significantly shortened (P < 0.01), the number of attacks and the cumulative attack time were significantly increased (P < 0.01), and the body mass and thymus index were significantly decreased compared with the control group (P < 0.05 or P < 0.01). In the 7-and 14-day model groups, the expression level of TIGIT in thymus and peripheral blood mononuclear cells was significantly higher than the control group (P < 0.01), while the CD4+/CD8+ ratio level of the peripheral blood T cell subsets was significantly lower than the control group (P < 0.05 or P < 0.01). The CD4+/CD8+ ratio of T cell subsets in the peripheral blood of random samples of rats was negatively correlated with the expression level of TIGIT in T cells of thymus (r2=0.627 0, P < 0.000 1) and in mononuclear cells (r2=0.624 4, P < 0.000 1). These results indicate that the model rats in the stress-induced anger state have obvious changes in animal behavior, present with thymus atrophy and abnormalities in peripheral blood T lymphocyte subsets CD4+/CD8+ ratio and immune function. This phenomenon may be related to the thymus and peripheral blood mononuclear cells TIGIT expression level, but the specific mechanism needs to be elucidated further.

Objective To analyze the curative effect of traditional Chinese medicine(TCM)combined with early enteral nutrition(EN)for treatment of patients with severe acute pancreatitis(SAP). Methods 70 SAP patients were randomly divided into TCM plus EN group(36 cases)and conventional therapy group(34 cases). Both groups received routine treatment. Additionally,TCM+EN group received early EN and TCM decoction treatment〔the ingredients of decoction including radix bupleuri,radix paeoniae alba,radix scutellariae,fructus aurantii immaturus, magnolia bark,raw rhubarb(rhubarb was added at last during cooking the decoction)and natrii sulfas exsiccatus (dissolved in water to be administered)each 10 g,the decoction was concentrated to 150 mL and then administered via a stomach tube to the patient,afterwards the tube was clipped for 2.5-3 hours,twice a day,4-7 days constituting a therapeutic course〕. After treatment,the time for patients' symptoms improvement,the situation of intestinal recovery, the length of stay in hospital,the total medical cost,serum C-reactive protein(CRP),aspartate aminotransferase (AST), lactate dehydrogenase (LDH), amylase (AMY), acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and complications,intensive care unit(ICU)transfer rate and case fatality rate in two groups were observed. Results The time for symptoms improvement of abdominal tenderness(day:1.68±1.01 vs. 3.89±1.07), abdominal distension(day:2.17±1.48 vs. 4.24±3.23),abdominal pain(day:3.12±1.14 vs. 4.94±3.21)and the intestinal recovery of exhaust defecation time(day:3.48±0.92 vs. 5.32±3.30)of SAP patients after treatment in the TCM+EN group were faster significantly than those in the conventional therapy group(all P<0.05). The length of stay in hospital(day:15.50±1.75 vs. 19.35±1.69)and total cost(wan yuan:1.812±0.424 vs. 3.292±1.081) of TCM+EN group were less than those of conventional therapy group(P<0.05 or P<0.01). After treatment,the levels of serum CRP,AST,LDH,AMY,APACHEⅡscore in TCM+EN group and conventional therapy group were all lower than those before treatment,and on day 10,the degree of descent was more prominent in TCM+EN group〔CRP(mg/L):98.972±43.384 vs. 122.392±71.621,AST(U/L):75.952±55.668 vs. 126.391±47.431, LDH (μmol?s-1?L-1):1.48±0.21 vs. 2.61±1.46,AMY(U/L):146.362±58.792 vs. 226.392±37.692,APACHE Ⅱscores:6.978±3.352 vs. 13.652±7.621,P<0.05 or P<0.01〕. There was no death in TCM+EN group,while in the conventional therapy group,there was 1 case dead. ICU transfer rate in TCM+EN group was less than that in the conventional therapy group(2.78% vs. 11.76%),but there was no statistical significant difference between the two groups(χ2=0.99,P>0.05). Among the 70 patients with SAP,the cause of the disease due to gallstone accounted for 55.72%,hyperlipidemia for 37.14%,alcoholic for 4.28%and other 2.86%. Conclusion The use of TCM combined with early EN for treatment of patients with SAP can enhance the curative effect of SAP,reduce the hospitalization time and the total cost of patients,and decrease complications and mortality,that is conducive to the faster recovery of patients.

Objective To analyze the efficacy and safety of DCF and XELOX regimens in the treatment of advanced gastric cancer and to explore the appropriate chemotherapy regimen for advanced gastric cancer.Methods 63 patients with advanced gastric cancer were divided into two groups.Group A (31 patients) was administered with DCF regimen,with docetaxel 60-75 mg/m2 on day 1,5-fluorouracil 500 mg/m2 on day 1 to day 5,cisplatin 75 mg/m2 on day 1,a total cycle of 21 days.Group B (32 patients) was performed with XELOX regimen,with oxaliplatin 130 mg/m2 on day 1,capecitabine 100 mg/m2 twice a day on day 1 to day 14.Results 63 cases were eligible to analyze the efficacy and adverse reactions.The efficient rate (PR+CR) of group A and B were 58.1％ and 62.5 ％,respectively.The median survival time were 10.9 months and 11.5 months,but there were no significant difference between the two groups (P ＞ 0.05).The patients in both groups showed the similar tolerance of adverse reaction.Bone marrow suppression above level 3 in group A (16.1％) was higher than that in group B (9.3 ％).Hair loss above level 2-3 in group A was higher (77.4 ％).Hand-foot syndrome in group B (68.8 ％) was higher than that in group A (9.6 ％).Mild liver function damage in group B (37.5 ％) was higher than that in group A (16.1％).Conclusion The DCF and XELOX schemes have the similar effect in the treatment of advanced gastric cancer with the tolerate side effect.

Objective To investigate the incidence and distribution of aberrational karyotype in acute myeloid leukemia (AML), and study the significance of the grouping by Southwest Oncology Group/Eastern Cooperative Oncology Group (SWOG/ECOG) in the prognosis of AML Methods The chromosome was prepared with brief culture of bone marrow, and the karyotype was analysed by G banding technique. All the patients were grouped according to the criterion of SWOG/ECOG, and the survival function of different groups was observed by the Kaplan-Meier method.Results 56 (67.47 %) out of 83 patients had clonal chromosome aberrations. Among those 56 patients, AML with translocation (15;17) and with translocation (8;21) presented in 30 patients(53.57 %), and the other kinds of aberrational karyotypes shared the left proportion. Among the 74 followed-up patients, 42 patients were dead. Among three groups with favorable, intermediate and adverse prognosis respectively, there is a significant difference (P <0.001). The complete remission rate of favorable group is higher than that of both intermediate and adverse (P <0.05). There is no difference between intermediate and adverse groups(P>0.05). Conclusion Cytogenetic aberration is one of the important factors affecting the effect on prognosis. The criterion of SWOG/ECOG can predict prognosis objectively.

Objective To determine the influencing factors on informed consent associated with decline or delay of primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods This study was conducted in Peking University People′s Hospital from 1 August, 2014 to 31 March, 2016, with 229 consecutive cases of acute STEMI enrolled in the study.Data were collected by reviewing medical records and STEMI treatment time records.180 patients with ischemic symptoms ≤12 hours were included in the final analysis.Patients were divided into the consent group and the refusal group according to the final decision.For patients who received primary PCI, they were further categorized into two groups based on the 30min cut-off time.Results Among the 180 STEMI patients reviewed, 139 patients agreed to primary PCI and the remaining 41 patients refused primary PCI.Multivariate logistic analysis showed that symptom relief (OR 5.532, 95% CI 1.165-26.278, P=0.031) and history of chronic kidney disease (OR 4.786, 95% CI 1.346-17.011, P=0.016) were predictors of dissent of primary PCI.Self-rated symptoms severity (OR 0.094, 95% CI 0.034-0.260, P<0.001)was predictor of consent to primary PCI.106 patients had complete time point records of informed consent in the consent group (n=139).Among these patients, the median informed consent delay was 24 min.64 patients made a decision within 30 minutes, and the other 42 patients had their decision made beyond 30 minutes.Symptom-to-door time ≥4 hours (OR 4.563,95% CI 1.682-12.385, P=0.003) was independent predictor of informed consent delay.Conclusions Patients with resolved symptoms, self-rated mild symptoms or renal insufficiency were more inclined to refuse primary PCI.For patients who eventually received primary PCI, symptom-to-door time ≥4 hours was the independent predictor of informed consent delay.

Objective: To investigate the migration characteristics and follow-up treatment among HIV/AIDS patients after HIV confirmation in Yiwu City, Zhejiang Province from 2016 to 2020, so as to provide insights into the optimization of the HIV/AIDS control strategy among floating populations. Methods: The reported HIV/AIDS patients' demographics, follow-up and treatment data in Yiwu City from 2016 to 2020 were captured from the HIV/AIDS Prevention and Control Information System of Chinese Disease Control and Prevention Information System. The migration characteristics, antiretroviral therapy and outcomes of HIV/AIDS patients were analyzed after HIV confirmation, and the factors affecting the migration of HIV/AIDS patients after HIV confirmation were identified using a Cox proportional hazard regression model. Results: A total of 1 189 HIV/AIDS patients were enrolled, including 988 men (83.10%) and 806 cases without Zhejiang provincial household registration (67.79%). There were 441 patients (37.09%) migrating out of Yiwu City after HIV confirmation, with a migration rate of 17.73/100 person-years, and there were 366 patients migrating out of Zhejiang Province, with a cross-province migration rate of 30.78%. Among participants without Zhejiang provincial household registration, 395 patients (49.01%) migrated out of Yiwu City, including 337 patients (85.32%) returning to their household registration provinces, which mainly included Yunnan, Sichuan, Guizhou and Hunan. Cox proportional hazard regression analysis showed a high risk of migration among minority ethnic populations (HR=1.375, 95%CI: 1.044-1.811), retires (HR=3.605, 95%CI: 1.771-7.335), students (HR=8.969, 95%CI: 4.095-19.645), patients without Zhejiang provincial household registration (HR=4.545, 95%CI: 3.164-6.529) and patients identified through physical examination of floating populations or employees (HR=1.318, 95%CI: 1.006-1.727), and a low risk among married patients with spouses (HR=0.721, 95%CI: 0.569-0.913) and with an educational level of junior high school and above (HR: 0.428~0.753, 95%CI: 0.280-0.952). Among all floating HIV/AIDS patients, there were 26 cases lost to follow-up (5.90%) and 49 deaths (11.11%). In addition, the proportion of absence of antiretroviral therapy, HIV infection progressing into AIDS patients and failure in HIV inhibition were all greater among floating HIV/AIDS patients than among non-floating patients (P<0.05). Conclusions A high risk of migration was found among HIV/AIDS patients without Zhejiang provincial household registration, unmarried patients, patients with a low education level, retirees, students, and patients identified through physical examination of floating populations or employees in Yiwu City from 2016 to 2020, and migration does not facilitate the sustainability of antiretroviral therapy and follow-up, which may affect the prognosis of HIV/AIDS.

Objective To observe the changes of brain neurotransmitters in patients with vasovagal syncope (VVS) with encephalofluc-tuogram technology (ET). Methods From August, 2015 to December, 2016, 30 patients with VVS were selected as case group, 30 controls matched with sex and age were selected from the outpatients without syncope. They were detected the function of gamma aminobutyric acid (GABA), glutamate (Glu), 5-hydroxytryptamine (5-HT), acetylcholine (Ach), norepinephrine (NE) and dopamine (DA) with ET. Results There was no significant difference between the two groups in the values of GABA, Glu, 5-HT, Ach and DA (t<1.680, P>0.05), while the values of NE was higher in the case group than in the control group (t=-3.552, P<0.001). Conclusion VVS may be related to the high level of activity of NE in the brain.

OBJECTIVETo study chemical constituents of leaves from Discocleidion rufescens.

METHODColumn chromatography and spectroscapic methods were used to isolate and identify the constituents.

RESULTFifteen compounds were isolated and identified as chrysophanol (1), physcione (2), taraxerol (3), beta-sitosterol (4), daucosterol (5), scopoletin (6), apigenin (7), acacetin-7-O-beta-D-glucoside (8), apigenin-7-O-beta-D-glucoside (9 ), luteolin (10), diosmetin-7-O-beta-D-glucoside (11), luteolin-7-O-beta-D-glucoside (12), gallic acid (13), amentoflavone (14) and myo-inositol (15).

CONCLUSIONCompounds 1, 2, 8, 11, 13 and 15 were isolated from the genus Discocleidion for the first time.

Euphorbiaceae ; chemistry ; Flavones ; analysis ; isolation & purification ; Plant Extracts ; analysis ; isolation & purification ; Sitosterols ; analysis ; isolation & purification

Neurocritical care (NCC) is not only generally guided by principles of general intensive care, but also directed by specific goals and methods. This review summarizes the common pulmonary diseases and pathophysiology affecting NCC patients and the progress made in strategies of respiratory support in NCC. This review highlights the possible interactions and pathways that have been revealed between neurological injuries and respiratory diseases, including the catecholamine pathway, systemic inflammatory reactions, adrenergic hypersensitivity, and dopaminergic signaling. Pulmonary complications of neurocritical patients include pneumonia, neurological pulmonary edema, and respiratory distress. Specific aspects of respiratory management include prioritizing the protection of the brain, and the goal of respiratory management is to avoid inappropriate blood gas composition levels and intracranial hypertension. Compared with the traditional mode of protective mechanical ventilation with low tidal volume (Vt), high positive end-expiratory pressure (PEEP), and recruitment maneuvers, low PEEP might yield a potential benefit in closing and protecting the lung tissue. Multimodal neuromonitoring can ensure the safety of respiratory maneuvers in clinical and scientific practice. Future studies are required to develop guidelines for respiratory management in NCC.
Humans ; Lung ; Lung Diseases/etiology* ; Positive-Pressure Respiration/methods* ; Respiration, Artificial/adverse effects* ; Tidal Volume

Objective:To investigate the clinical characteristics and possible mechanisms of remote intracranial hematoma (RIH) in patients with intracranial aneurysm after interventional embolization.Methods:Six patients with RIH from a series of 58 consecutive patients with intracranial aneurysm, admitted to and performed interventional embolization in our hospital from January 2016 and December 2018, were chosen in our study. Their clinical data were analyzed retrospectively and compared with those without RIH at the same period.Results:In these 6 patients, 4 had history of hypertension, 5 had aneurysm located in the internal carotid artery, 5 were treated with stents combined with postoperative routine anticoagulation treatment. The remote intracranial hematoma occurred within 7 d of interventional embolization, and the hematoma was located in the cerebral hemisphere on the same side of the aneurysm; 4 patients underwent intracranial hematoma puncture catheter drainage; 1 patient was treated conservatively, and one was treated by craniotomy. After treatment, 1 patient recovered (modified Rankin scale [mRS] score of 1), 1 patient had poor prognosis (mRS scores of 5) and discharged automatically, and the rest 4 patients (mRS scores of 3-5) left some degrees of neurological dysfunction. As compared with 52 patients without RIH, 6 patients with RIH had significantly higher percentages of patients used stents and postoperatively used anticoagulation, and higher percentages of patients with poor clinical outcomes at discharge ( P<0.05). Conclusion:Stent-assisted coil embolization in patients with internal carotid artery aneurysm combined with hypertension should be highly vigilant about the possibility of RIH.