BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

OBJECTIVETo investigate the protective effect of ginsenoside Rg1 on oxygen-glucose deprivation (OGD) in PC-12 cells, and preliminarily discuss the potential molecular mechanism of mTOR/Akt/FoxO3 signaling pathway.

METHODThe OGD PC-12 cell model was established. The cell viability was measured by MTT assay. After the pretreatment with Rg1 with the concentration of 10, 20, 40 micromol x L(-1) for 24 h, the cell viability was observed. Lactate dehydrogenase (LDH) release, superoxide dismutase (SOD) ac- tivity and malondialdehyde (MDA) level were detected by colorimetry assay. mTOR, p-Akt(ser473), p-Akt(tjr308), Akt, p-FoxO3, FoxO3 in cytoplasm and nucleus, and total FoxO3 protein expression were detected by Western blot assay.

RESULTOGD could significantly in- hibit cell proliferation in 4-24 h in a time-dependent manner. After pretreatment for 24 h, Rg1 (20, 40 micromol x L(-1)) could notably elevate the cell viability and SOD viability and reduce the LDH release and MDA content. Besides, Rg1 also inhibited OGD-induced mTOR and p-Akt(ser473) decreases. After treatment for 6 h, OGD could reduce FoxO3 phosphorylation and promote FoxO3 in cytoplasm. This data suggested that Rg1 could protect PC-12 cell injury through mTOR/p-Akt/FoxO3 signaling pathway.

CONCLUSIONGinsenoside Rg1 could attenuate OGD-induced PC-12 cell injury. Its action mechanism may be closely related to activation of mTOR/p-Akt/FoxO3 signaling pathway.

Animals ; Apoptosis ; drug effects ; Cell Proliferation ; drug effects ; Cell Survival ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; Forkhead Box Protein O3 ; Forkhead Transcription Factors ; genetics ; metabolism ; Ginsenosides ; pharmacology ; Glucose ; metabolism ; Oxygen ; metabolism ; PC12 Cells ; Protective Agents ; pharmacology ; Proto-Oncogene Proteins c-akt ; genetics ; metabolism ; Rats ; Signal Transduction ; drug effects ; TOR Serine-Threonine Kinases ; genetics ; metabolism

Adolescent ; Adult ; Animals ; Bites and Stings ; Dog Diseases ; virology ; Dogs ; Female ; Humans ; Male ; Middle Aged ; Nucleocapsid Proteins ; genetics ; Phylogeny ; Post-Exposure Prophylaxis ; Rabies ; prevention & control ; veterinary ; virology ; Rabies Vaccines ; immunology ; Young Adult

OBJECTIVETo study the efficacy and safety of Naoxintong capsule treatment of stroke recovery with Qi-deficiency and blood-stasis syndrome (cerebral infarction), and to compared the non-inferiority analysis with the positive drug Tongxinluo capsule.

METHODTaking Tongxinluo capsules as control, randomized, double-blind, controlled, multi-center clinical experiments were studied. The evaluating indexes included the decrease of integral value of stroke patients, changes in traditional Chinese medicine, the improvement of the patient viability status (disability level), Chinese stroke scale (CSS), activities of daily living (DAL) scale and barthel index (BI ) points.

RESULTThe total effect of the two groups, Chinese and other symptoms, showed no significant statistical significance.

CONCLUSIONNaoxintong capsule stroke recovery, with Qi-deficiency and blood-stasis syndrome (cerebral infarction) has a therapeutic effect, and more secure.

Activities of Daily Living ; Adult ; Aged ; Capsules ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Qi ; Stroke ; drug therapy ; Treatment Outcome

OBJECTIVETo evaluate the survival rate after pulmonary resection for metastatic colorectal cancer(CRC).

METHODSClinical data of 77 patients with pulmonary metastasis from CRC between January 2005 and October 2008 in the Zhongshan Hospital, Fudan University were retrospectively analyzed.

RESULTSThere were 38 patients with synchronous pulmonary metastasis, of whom 2 underwent resection for pulmonary metastasis. The median survival time of two groups was 25 months and 18 months, which was not significantly different (P=0.33). There were 39 cases of metachronous pulmonary metastasis, of whom 28 received pulmonary metastasis resection. The 1-year and 3-year survival rates of 2 groups were 93.3% and 58.5%, and 38.8% and 19.1%, respectively. The median survival time of two groups was 26.7 months and 8 months, and the difference was statistically significant (P=0.004).

CONCLUSIONSurgical resection can improve the survival rate in patients with pulmonary metastasis from colorectal cancer.

Colorectal Neoplasms ; mortality ; pathology ; surgery ; Female ; Humans ; Lung Neoplasms ; mortality ; secondary ; surgery ; Middle Aged ; Neoplasm Metastasis ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo study the effect of Panax notoginseng saponins (PNS) on (synaptophysin, syp) and tau gene expression in the brain tissue in senescence accelerated mouse prone 8 (SAMP 8).

METHODSAMP8 were randomly divided into 4 groups: PNS 23.38, 93.50 mg x kg(-1) group, huperzin A 0.038 6 mg x kg(-1) x d(-1) group and blank control group; the drug groups were treated with the designed drugs respectively per day by intragastric administration for 4 consecutive weeks, and double distilled water was given to blank control group. After treatment, the mRNA content of tau and syp were assayed by reverse transcription (RT) and real-time polymerase chain reaction (real-time PCR).

RESULTCompared with blank control group, the syp mRNA contents were increased in PNS groups (P < 0.05 or P < 0.01), and the tau mRNA content were not significant difference in all groups.

CONCLUSIONThis study suggests that PNS can up-regulate syp gene expression at transcriptional level in the brain of SAMP 8.

Aging ; drug effects ; metabolism ; Animals ; Brain ; drug effects ; metabolism ; Gene Expression ; drug effects ; genetics ; Mice ; Panax notoginseng ; chemistry ; Protein Tyrosine Phosphatase, Non-Receptor Type 11 ; genetics ; metabolism ; Saponins ; pharmacology ; tau Proteins ; genetics ; metabolism

OBJECTIVETo investigate the protective effects of glycyl-glutamine dipeptide supplement on the function of myocardial dynamics in severely burned rats, and to explore its mechanism.

METHODSOne hundred and thirty-six Wistar rats were randomly divided into five groups: i. e, control group (C, n = 8, without burns), burn group (B, n = 32), Gln group (Gln, n = 32), Gly group (Gly, n = 32) and Gly-Gln group (Gly-Gln, n = 32). The rats in the latter four groups were respectively treated with tyrosine (1.5 g x kg(-1) x d(-1)), glutamine (1.0 g x kg(-1) x d(-1)) and tyrosine (0.5 g x kg(-1) x d(-1)), glycine (0.5 g x kg(-1) x d(-1)) and tyrosine (1.0 g x kg(-1) x d(-1)), and Glycyl-glutamine dipeptide (1.5 g x kg(-1) x d(-1)) after receiving a 30% TBSA full-thickness burn on the back. Glutathione (GSH), adenosine monophosphate (AMP), adenosine diphosphate (ADP), adenosine triphosphate (ATP), cell energy charge (EC) and the index of myocardial dynamics (ASOP, AODP, LVSP, + dp/dtmax) were measured at 12, 24, 48, 72 post-burn hours (PBH).

RESULTSThe content of GSH, ATP, EC and the level of aortic systolic pressure (ASOP), aortic diastolic blood pressure (AODP), left ventricular end diastolic pressure (LVEDP) and maximum rate of intraventricular pressure rise/down (+ dp/dtmax) in B, Gln, Gly, Gly-Gln groups were obviously lower than those in C group (P < 0.01), while the levels of AMP and ADP showed an opposite tendency. Compared with B group, the above indices were ameliorated. The content of GSH (72.7 +/- 1.7) micromol/g in Gly-Gln group at 12 PBH was obviously higher than that in Gln group (67.8 +/- 3.8) micromol/g (P < 0.01). The levels of EC and AOSP were obviously higher in Gly-Gln group than that in Gln group (P < 0.01). The level of GSH, EC, AOSP in Gly-Gln groups were obviously higher than those in Gly group at 48 PBH.

CONCLUSIONGlycyl-glutamine dipeptide, Gly and Gln supplementation after burns can improve the content of GSH and high energy phosphate compound, and suppress the decline of myocardial dynamics function. The effects of Glycyl-glutamine dipeptide is better than single Gly or Gln, indicating that the protective effect on myocardial function after severe burns by Gln and Gly is synergistic.

Animals ; Burns ; drug therapy ; metabolism ; Dipeptides ; pharmacology ; Glutathione ; metabolism ; Glycine ; Myocytes, Cardiac ; drug effects ; metabolism ; Random Allocation ; Rats ; Rats, Wistar

OBJECTIVETo investigate the effect of short hairpin RNA (shRNA) targeting hypoxia-inducible factor-1 alpha (HIF-1 alpha) on the human breast carcinoma MCF-7 cell line.

METHODSThe hypoxia environment was achieved by treating cells with cobalt chloride. The shRNA eukaryotic expression vector targeting HIF-1 alpha was constructed, and transfected into MCF-7 cells through lipofectamine 2000. Semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) was used to study the expression of vascular endothelial growth factor (VEGF). The mRNA and protein level of HIF-1 alpha were detected by real-time PCR and Western blot. Sub-G1 apoptotic population analysis, Annexin V/PI binding assay, and DNA ladder analysis were applied to investigate the cell apoptosis. The cell cycle was detected by flow cytometry.

RESULTSThe mRNA and protein level of HIF-1 alpha increased after exposure of MCF-7 cells to hypoxia (P < 0.01). However, apoptosis was lower in hypoxia compared with normoxia (P < 0.05). The HIF-1 level of MCF-7 transfected with HIF-1 alpha shRNA decreased approximately 91.63% (P < 0.01). When the cells were treated with or without apoptosis inducer Ara-C, the apoptosis of MCF-7 cells transfected with HIF-1 alpha shRNA increased by 1.75 times (P < 0.01) and 61. 31 times (P < 0.01), respectively. The expression of VEGF in MCF-7 cells transfected with HIF-1 alpha shRNA decreased 66.8% compared with untransfected cells (P < 0.05). Cell cycle progression was inhibited when the MCF-7 cells were transfected with HIF-1 alpha shRNA.

CONCLUSIONSHIF-1 alpha plays an anti-apoptotic role in human breast carcinoma MCF-7 cell line. The shRNA we designed targeting HIF-1 alpha in MCF-7 can promote cell apoptosis, inhibit the expression of VEGF, and delay cell cycle progression.

Apoptosis ; Breast Neoplasms ; genetics ; metabolism ; pathology ; Cell Cycle ; Cell Line, Tumor ; Down-Regulation ; Female ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; genetics ; RNA Interference ; RNA, Messenger ; genetics ; RNA, Small Interfering ; genetics ; Transfection ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVETo assay ligustilide content in the herb of Szechwan Lovage Rhizome (Chuanxiong, CX), which is the dried rhizome of Ligusticum chuanxiong in order to assess the quality.

METHODLigustilide was quantitatively analyzed by high-performance liquid chromatography in 21 CX samples. An Alltima C18 column (4.6 mmx 150 mm, 5 microm) was used as the analytical column. The mobile phase consisted of water and acetonitrile (40:60). The flow rate was maintained at 1.0 mL x min(-1) with the column temperature at ambient conditions. The detection wavelength was set at 350 nm.

RESULTThe average content of Z-ligustilide in 21 CX samples was found to be 7.40 +/- 3.54 mg x g(-1)(x +/- s, n = 21). Therefore,the content of Z-ligustilide in CX should not be less than 0.66% (calculated on the dried basis).

CONCLUSIONThe overall analytical procedure is rapid and accuracy which is considered suitable for the quantitative analysis of ligustilide in CX. The amount of ligustilide in CX samples collected from different cultivation areas was obviously different. However, a relatively higher content of ligustilide was generally found in the CX collected from its main cultivated areas.

4-Butyrolactone ; analogs & derivatives ; analysis ; China ; Chromatography, High Pressure Liquid ; methods ; Ecosystem ; Ligusticum ; chemistry ; Plants, Medicinal ; chemistry ; Quality Control ; Reproducibility of Results ; Rhizome ; chemistry