1.Interactions between endothelial cells and smooth muscle cells of blood vessels in sepsis
Yisen ZHANG ; Xiaohan XU ; Bingwei SUN
Chinese Critical Care Medicine 2016;(2):180-183
Vascular endothelial cells (EC) and smooth muscle cells (SMC) are target and effecter cells of inflammation, and they play an important role in inflammatory responses. The abnormal structure and function of EC and SMC play a significant role in microcirculation disturbance in septic shock and multiple organ dysfunction. This review was meant to discuss the changes in structure and function of EC and SMC and their bidirectional regulation. The cellular linkage of EC and SMC is essential for the interactions between them, and it contributes to the course of sepsis. Paracrine and autocrine as produced by EC and SMC constitute a network for mutual adjustment. Replication of the interaction between EC and SMC facilitates the potential to support hemodynamics, tissue perfusion and cellular metabolism, thereby lower the mortality rate of sepsis. However, the detailed and specific mechanisms remain to be disclosed.
2.Efficacy of posaconazole in preventing invasive fungal disease in hematologic patients with neutropenia
Xiaohan XU ; Lu ZHANG ; Minghui DUAN
Chinese Journal of Infection Control 2017;16(1):32-35,57
Objective To evaluate the prophylactic efficacy and safety of posaconazole against invasive fungal disease(IFD)in hematologic patients with neutropenia.Methods Medical records of 18 hematologic patients with neutropenia received posaconazole for preventing IFD in a Beijing hospital between 2014 and 2015,the efficacy and safety was evaluated.Results There was no clinical diagnosis or confirmed diagnosis of IFD among 18 patients during posaconazole prophylaxis period,none of patients stopped posaconazole due to severe adverse reaction.Two patients with acute myeloid leukemia(AML) died of pulmonary infection,1 of whom isolated Stenotrophomonas maltophilia from sputum culture on the 12th day of posaconazole prophylaxis,the other isolated Escherichia coli from sputum culture on the 14th day of posaconazole prophylaxis.Other patients all adherence to posaconazole prophylaxis until granulocyte count recovered,patients were followed up until 100 days medication,no death occurred.The lowest peripheral neutrophil count was(0.00-0.27) x 109/L during posaconazole prophylaxis period,with the median of 0.02 x 109/L;the duration of posaconazole prophylaxis was 8-27days,with the median of 16 days;among patients without IFD breakthrough or received systemic use of other antifungal agents,there were 2 (11.1%) all-cause death within 100 days;there were no adverse reaction,such as liver function abnormalities≥grade 2 and kidney function abnormalities≥grade 2,as well as QTc prolongation.Conclusion Posaconazole is effective for preventing IFD in hematologic patients with neutropenia,adverse reaction is rare.
3.Survey on practice of hospice care and influencing factors among health providers in Shanghai
Yifan XU ; Limei JING ; Xiaohan TENG ; Zhiqun SHU ; Shuijing LI
Chinese Journal of General Practitioners 2021;20(5):562-567
Objective:To survey the practice of hospice care and influencing factors among health providers in Shanghai.Methods:From November to December in 2019, a sampling survey on the practice of hospice care was conducted among 2 982 health providers from 217 institutions in 16 districts of Shanghai by using the self-designed scale.Results:The overall behavior frequency of hospice care in health providers was between "occasionally" (3 points) and "often" (4 points). The item score was (3.7±0.9), and the total score was (52.1±10.0). In the aspect of building a good relationship with patients and family(77.7%, 2 317/2 982), the participants had the highest work-practice(46.4%, 1 383/2 982). However, they practiced less in recommending the hospice care institutions to terminal patients. In terms of work-practice, the average score in male providers, those with education of undergraduate and above, those being married (including divorced or widowed), medical staff, those with associated senior titles, with witness of dying, or those currently working in the hospice care service department was higher.Conclusions:The hospice care work-practice of health providers in Shanghai is generally satisfactory, however, there is still some discrepancy among health providers with various characteristics. To further improve quality of hospice care, it is necessary to strengthen policy implementation, to encourage multidisciplinary team cooperation and carry out various forms of professional training for health providers.
4.Evaluation of lumbar intervertebral disc degeneration with synthetic MRI
Weilan ZHANG ; Jingyi ZHU ; Xiaohan XU ; Guoguang FAN
Chinese Journal of Radiology 2021;55(6):621-626
Objective:To investigate the value of synthetic MRI for evaluating lumbar intervertebral disc degeneration.Methods:A total of 414 lumbar intervertebral discs from 85 patients were included prospectively from September 2018 to February 2019 in First Affiliated Hospital of China Medical University. The T 1, T 2 and proton density (PD) mapping were generated from synthetic MRI. Two doctors measured the T 1, T 2 and PD values to evaluate intraobserver agreement by using ICC. For Pfirrmann grade comparisons, the variables with normal distribution were analyzed with the one-way analysis of variance, whereas those with skewed distribution were analyzed with the Kruskal-Wallis H test. Furthermore, the ROC curves were used on significant parameters to evaluate their diagnostic efficacy. The Z test was used to compare the differences of area under the ROC curves (AUC). Results:The color of the quantitative mapping changed along with the increase of the Pfirrmann grade of the intervertebral discs, which corresponded to the decrease of the T 2WI signal intensity. The ICC values of the quantitative values of nucleus pulposus indicated excellent agreement (ICC>0.900), followed by anterior annulus fibrosus (ICC>0.700) and then the posterior annulus fibrosus (ICC>0.600). The results of the adjacent Pfirrmann grade comparisons were as follows: between Pfirrmann grade Ⅰ and Ⅱ, the differences of T 2 and PD values of nucleus pulposus were statistically significant ( P=0.004 and P<0.001, respectively); between Pfirrmann grade Ⅱ and Ⅲ, the differences of T 1, T 2 and PD values of nucleus pulposus were statistically significant (all P<0.001); between Pfirrmann grade Ⅲ to Ⅳ, the T 1, T 2 and PD values of nucleus pulposus (all P<0.001) and the T 1 and PD values of posterior annulus fibrosus ( P=0.025, P<0.001, respectively) had statistically significant differences; between Pfirrmann grade Ⅳ to Ⅴ, the difference of T 2 values of nucleus pulposus were statistically significant ( P=0.031). The AUC of T 2 values of nucleus pulposus between Pfirrmann grade Ⅱ to Ⅲ and grade Ⅳ to V were higher than those of the PD values ( Z=2.443, 3.591 and P=0.015,<0.001). Conclusions:Synthetic MRI can quantitatively evaluate lumbar disc degeneration, in which the T 2 value of nucleus pulposus may be the most effective parameter with high repeatability.
5.Suppressive effect of exogenous carbon monoxide on abnormal platelet exocytosis and its molecular mechanism in sepsis
Dadong LIU ; Xiaohan XU ; Mingfeng ZHUANG ; Mingming SONG ; Weiting QIN ; Xu WANG ; Bingwei SUN
Chinese Critical Care Medicine 2016;(2):110-116
Objective To investigate the suppressive effect of exogenous carbon monoxide (CO) on abnormal platelet exocytosis and its possible molecular mechanism. Methods Venous blood was collected from healthy volunteers. Platelet-rich plasma (PRP) was isolated from the blood by differential centrifugation. The PRP was randomly divided into five groups by random number table, namely normal control group, lipopolysaccharide (LPS) group (challenged with 10 mg/L LPS), inactively exogenous carbon monoxide releasing molecule 2 (iCORM-2) group (given 10 mg/L LPS + 50 μmol/L iCORM-2 for intervention), exogenous carbon monoxide releasing molecule 2 (CORM-2) 10 μmol/L and 50 μmol/L groups (given 10 mg/L LPS + CORM-2 10 μmol/L or 50 μmol/L for intervention). After 30 minutes, enzyme linked immunosorbent assay (ELISA) was used to determine the platelet-derived growth factor BB (PDGF-BB) and matrix metalloproteinase 2 (MMP-2). Chemical fluorescein method was used to determine the platelet adenosine triphosphate (ATP). Flow cytometer was used to determine the expression of P-selectin. The expressions of Toll-like receptor 4 (TLR4), phosphorylation of protein kinase Cθ (PKCθ) and syntaxin binding protein 1 (STXBP-1) were determined by Western Bolt. The soluble N-ethylmaleimide-sensitive factor-attachment protein receptors (SNAREs) complex formation [syntaxin 2-synaptosomal-associated protein 23-vesicle associated membrane protein 8 (STX2-SNAP23-VAMP8)] mediated by STXBP-1 was determined by immunoprecipitation. Results ① Compared with normal control group, the platelet release of PDGF-BB, MMP-2 and ATP was significantly increased after LPS challenge, and the P-selectin expression of platelet was also obviously up-regulated [PDGF-BB (μg/L): 127.53±1.78 vs. 94.35±5.84, MMP-2 (ng/L): 51.87±9.20 vs. 35.83±3.17, ATP (μmol/L): 1.288±0.056 vs. 0.975±0.010, P-selectin: (3.93±0.19)% vs. (0.44±0.10)%, all P < 0.05]. The increases in platelet release of PDGF-BB, MMP-2 and ATP were suppressed by 10 μmol/L or 50 μmol/L CORM-2 administration, as well as high-expression of P-selectin in a dose-dependent manner [PDGF-BB (μg/L): 114.68±1.35, 97.08±6.14 vs. 127.53±1.78, MMP-2 (ng/L): 32.67±8.00, 24.63±1.63 vs. 51.87±9.20, ATP (μmol/L): 0.999±0.015, 0.965±0.008 vs. 1.288±0.056, P-selectin: (1.95±0.27)%, (0.94±0.11)% vs. (3.93±0.19)%, all P < 0.05]. ② Compared with normal control group, LPS challenge resulted in a significant increase in the expression of TLR4 and the phosphorylation of PKCθ and STXBP-1 [TLR4 (gray value): 1.21±0.38 vs. 0.67±0.06, p-PKCθ (gray value): 1.36±0.20 vs. 0.44±0.03, p-STXBP-1 (gray value): 1.13±0.06 vs. 0.59±0.04, all P < 0.05]. The increases in above parameters were suppressed by 10 μmol/L or 50 μmol/L CORM-2 administration in a dose-dependent manner [TLR4 (gray value): 0.76±0.05, 0.65±0.04 vs. 1.21±0.38; p-PKCθ (gray value): 0.71±0.07, 0.47±0.10 vs. 1.36±0.20; p-STXBP-1 (gray value): 0.56±0.02, 0.48±0.01 vs. 1.13±0.06, all P < 0.05]. ③ Compared with normal control group, the SNAREs proteins in platelet that combined with STXBP-1, including STX2, SNAP23 and VAMP8, were obviously increased after LPS challenge [STX2 (gray value): 1.35±0.06 vs. 0.57±0.04, SNAP23 (gray value): 0.97±0.04 vs. 0.30±0.12, VAMP8 (gray value): 1.37±0.12 vs. 0.77±0.10, all P < 0.05]. The increases in SNAREs complex formation were suppressed by 10 μmol/L or 50 μmol/L CORM-2 administration in a dose-dependent manner [STX2 (gray value): 0.77±0.02, 0.39±0.03 vs. 1.35±0.06, SNAP23 (gray value): 0.41±0.03, 0.22±0.08 vs. 0.97±0.04, VAMP8 (gray value): 0.85±0.07, 0.66±0.07 vs. 1.37±0.12, all P < 0.05]. There was no significant difference in the above mentioned parameters between iCORM-2 group and LPS group. Conclusions LPS-induced abnormal secretion of platelet was suppressed by CORM-2 administration. The mechanism may involve the TLR4/PKCθ/STXBP-1 signaling pathway activation and the SNAREs complex formation.
6.Determination of the composition of kidney stones and prediction of the efficacy of extracorporeal shock-wave lithotripsy by X-rays
Changbao XU ; Bin HAO ; Youzhi WANG ; Xinghua ZHAO ; Liang YAN ; Xiaohan CHU ; Yuan LV
Chinese Journal of Urology 2012;33(1):13-15
Objective To evaluate the clinical value of determination of composition of kidney stones by shap and density and of prediction of the efficacy of extracorporeal shock-wave lithotripsy (ESWL) by X-rays. Methods The data of 358 patients were analyzed,with 204 male and 154 female and with 276 cases of solitary stones and 82 cases of multiple stones.Determine the composition of kidney stones by shap and density,predict the efficacy of ESWL by X-rays,and choose the appropriate method of treatment.Analyze stone chemical property by Infrared stone composition automatic analyzer to checkout the prediction results before surgeries. Results 339 cases were successful to remove stones after treatment.The prediction results of 308 cases (86.0%) were consistent in stone chemical property,and the preperative prediction results of 339 cases (94.7%) were consistent in ESWL efficacy. Conclusions Determination of composition of kidney stones and prediction of the efficacy of ESWL by X-rays were feasible.
7.Expression of ubiquitin editing enzyme A20 and its pathway in steatotic hepatocytes and monocytes
Luoyan AI ; Qingqing XU ; Changwei WU ; Dazhi SU ; Xiaohan WANG ; Zhiwei CHEN ; Zhuping FAN
Chinese Journal of Digestion 2015;35(4):247-251
Objective To investigate the changes of A20 expression stimulated by free fatty acids (FFA) and its pathway.Methods HepG2 cells and U937 cells were stimulated by 0.5 mmol/L mixed FFA.The expression of A20,phosphor-p65 and phosphor-IκBα of neclear factor (NF)-κB pathway and phosphor-c-Jun N-terminal kinase (JNK),JNK,phosphor-extracellular signal-regulated kinase (ERK),ERK,phosphor-p38 and p38 of mitogen-activated protein kinase (MAPK) pathway were detected by Western blotting.The level of interleukin (IL)-12p,IL-1β,tumor necrosis factor (TNF)-α,IL-6,IL-10 and IL-8 cytokines in the supernatant of cell culture were detected by flow cytometry.T-test was performed for statistical analysis.Results The level of A20 changed along with the stimulated time of FFA.NF-κB and MAPK pathways were activated after FFA stimulation.The secretion of IL-6 and IL-8 increased after HepG2 cells stimulated by FFA and both reached peak at 24 hour.Compared with control group,the difference in IL-8 was statistically significant ((423.8 ± 8.9) pg/mL vs (12.4 ± 4.5) pg/mL,t=41.28,P<0.01).The difference in IL-6 was also statistically significant ((4 082±423.6) pg/mL vs (52.9±29.5) pg/mL,t=9.49,P<0.01).After U937 cells were stimulated by FFA,the secretion of IL-8 increased compared with control group.And in a certain period of time the secretion was time dependence.The maximum secretion of 24 hours was (200.6±5.7) pg/mL vs (5.0±3.9) pg/mL,and the difference was statistically significant (t=28.16,P<0.01).IL-10,IL-12p,IL-1β and TNF-α were detected.Both NF-κB pathway and MAPK pathway were detected.Conclusions The in vitro FFA mediated steatotic cell model could induce the expression change of A20 and secretion of inflammatory cytokines.NF-κB and MAPK pathways involved in the response to FFA in HepG2 cells and U937 cells.
8.The impact of cigarette cessation intervention on mental state of patients with coronary heart disease
Zhiming ZHOU ; Xiaohan XU ; Jing LIANG ; Bin HU ; Yujing CHENG ; Chao SHI ; Yujie ZHOU
Chinese Journal of Internal Medicine 2016;55(11):854-858
Objective This study was designed to observe the impact of cigarette cessation on anxiety and depression in patients with coronary heart disease (CHD).Methods A total of 690 cigarette smoking patients with CHD identified by coronary angiography (CAG) were included and analyzed in the study.The mental state were scored with Hamilton anxiety (HAMA) and depression (HAMD) scale both on admission and at 6-month follow-up.The patients were divided into two groups based on the cigarette cessation.The score of mental state between the two groups were compared.The patients were treated with percutaneous coronary intervention (PCI),coronary artery bypass grafting (CABG),or medicine therapy (MT).Results The clinic data and score of mental state were similar at the time of admission (HAMA:10.66±5.53 vs 11.09 ±5.61,P =0.311;HAMD:29.81 ± 10.13 vs 28.94 ± 10.22,P =0.266 4) between the two groups.After 6 months,the proportions of subjects in smoking cession group with anxiety (24.2% vs 32.3%,P <0.05),depression (18.0% vs 27.5%,P <0.05),and anxiety and depression (7.0% vs 16.2%,P <0.001) decreased significantly compared with those in smoking group irrespective of the treatment strategy.Both the HAMA and HAMD scores were lower in smoking cessation group (HAMA:9.83±3.40;HAMD:24.91 ±7.90) than in smoking group (HAMA:10.98 ±4.87;HAMD:27.70 ± 11.16) (all P < 0.001).Conclusions Smoking cessation is good for the relief of anxiety and depression in CHD patient.
9.Clinical application of physical vibration lithecbole in upper urinary calculi after extracorporeal shock-wave lithotripsy
Changbao XU ; Youzhi WANG ; Xiaohan CHU ; Bin HAO ; Xinghua ZHAO ; Xiaofu WANG
Chinese Journal of Urology 2013;34(8):599-602
Objective To observe the curative effect of external physical vibration lithecbole (EPVL) therapy after extracorporeal shock-wave lithotripsy (ESWL) in upper urinary calculi.Methods A total of 133 patients of upper urinary calculi with randomly divided into 2 groups after ESWL therapy during the period of 2012 October to 2013 February.The EPVL group (66 cases) used the physical vibration lithecbole treatment,and the natural lithecbole group (67 cases) used the method by drinking water,adding exercise and other natural lithecbole method.Of the EPVL group,6 of the stones were located in the upper or middle calyx,13 in renal pelvis,16 in lower renal calyx and 31 in ureter,the stone diameter was 10-15 mm.Of the natural lithecbole group,8 of the stones were located in the upper or middle calyx,17 in renal pelvis,15 in lower renal calyx and 27 in ureter,the stone diameter was 10-15 mm.The clinical data of the curative effect,side-effect,and complications were collected and analyzed systematically.Results In the EPVL group,the average times of lithagogue treatment was 2.6 times,51 patients (77%) expelled stones on the day of lithecbole,and the stone free rate in a week was 79% (52/66).Especially,81% (13/16) of the lower renal calyx expelled stones on the day of lithecbole,and the stone free rate in a week was 88% (14/16).Whereas,30 patients (45%) in the natural lithecbole group expelled stones on the day of ESWL,and the stone free rate in a week was 49% (33/67) ; the lower renal calyx stone expulsion rate on the day of ESWL was 33% (5/15),and the stone free rate in a week was 40% (6/15).The curative effects were significantly different between the 2 groups (P< 0.05).There were no serious complications in both groups.Conclusions EPVL machine can significantly promote the stone expulsion after ESWL.Compared with traditional methods,EPVL therapy has a better curative effect,especially on lower renal calyx stones.EPVL is a safe and noninvasive treatment.
10.Survey on knowledge and influencing factors of hospice care among health providers in Shanghai
Xiaohan TENG ; Zhiqun SHU ; Limei JING ; Yifan XU ; Shuijing LI ; Yongxing SHI ; Xiaoming SUN
Chinese Journal of General Practitioners 2021;20(4):452-457
Objective:To investigate the knowledge level of hospice care and the related influencing factors among health providers in Shanghai.Methods:From November to December 2019,a questionnaire survey on the hospice care knowledge was conducted among 7 074 health providers from 223 registered hospice care clinics or institutions in 16 districts of Shanghai.Results:A total of 7 027 valid questionnaires were recovered, with an effective recovery rate of 99.3%. Among the 7 027 responders, there were 1 460 males (20.8%) and 5 567 females (79.2%) with an mean age of (36.9±9.3) years; 2 682 nurses (38.2%) and 2 442 doctors (34.8%); 5 065 (72.1%) from community health service centers; 2 982 (42.4%) involving in hospice care services and 4 039 (57.5%) willing to work in hospice care. The average score of hospice care knowledge was (8.9±2.6), and the average accuracy for questions was 59.0%. Health providers had the highest awareness rate for the composition of hospice care professional team (93.9%, 6 597/7 027) and the lowest awareness rate for the emotional commitment in hospice care service (16.6%, 1 165/7 027). Health providers with junior colleges degree ( B=-0.429), vocational college degree and below ( B=-0.544), nurses ( B=-0.652), working in suburban areas ( B=-0.278), social office ( B=-0.891), without witness of dying process of end-of-life patients ( B=-0.329), not involving in hospice care services ( B=-0.283), and not willing to participating in hospice care ( B=-0.820) had low knowledge scores ( P<0.05). Conclusions:The overall level of hospice care knowledge of health providers in Shanghai is generally at a medium level, and the training of hospice care knowledge should be strengthened for the better development of hospice care.