Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34⁺⁰ weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.
Infant ; Infant, Newborn ; Humans ; Birth Weight ; Intensive Care Units, Neonatal ; Retrospective Studies ; Tertiary Care Centers ; Infant, Extremely Low Birth Weight ; Gestational Age ; Infant, Extremely Premature ; Sepsis/epidemiology* ; Retinopathy of Prematurity/epidemiology* ; Bronchopulmonary Dysplasia/epidemiology*

Objective To evaluate the predictive value of a combined model based on clinical and radiomics features for the invasiveness of lung adenocarcinoma manifesting as ground glass nodule(GGN).Methods Clinical data of patients with GGN-type lung adenocarcinoma who underwent chest CT and were confirmed by surgical pathology at some hospital from January to December 2019 were analyzed retrospectively,and the extraction of imaging histological features was performed using Python-based open resource Pyradiomics.A clinical model was constructed based on independent risk factors obtained from univariate and multivariate analyses,a radiomics model was built using the screened radiomics features,and a combined model was established with the predictive values of the clinical models and radiomics scores(Radscore).The predictive performance of the three models in the training and test sets was assessed using ROC curves,the statistical significance of the differences in the ROC curves of the three models for predicting GGN-type lung adenocarcinoma was assessed using the Delong test,and the net benefits of the models were analyzed using clinical decision curves.Results Logistic multifactor analysis showed that age(P=0.020 2)and vascular characteristics(P=0.002 2)were the independent predictors of the degree of the invasiveness of lung adenocarcinoma.The AUCs of the radiomics model,clinical model and combined model were 0.876,0.867 and 0.904 on the training set,and 0.828,0.828 and 0.864 on the test set,respectively.The difference between the ROC curves of the combined model and the clinical and radiomics models was not statistically significant(P>0.05)on the test set.Clinical decision curves showed a higher clinical benefit when using the combined model to predict the invasiveness under most conditions of threshold probability.Conclusion The combined model based on clinical and radiomics features enhances the predictive performance for the invasiveness of GGN-type lung adenocarcinoma.

Objective: To develop a set of data elements and standardized definitions of Coronary Artery Disease and Creative Antithrombotic Clinical Research Collaboration (CardiaCare), aiming to facilitate the exchange of disparate data sources, enhance the abilities to support multicenter researches, and subsequently ensure the databases use under standardized process and criteria. Methods: The Cardiacare writing committee members reviewed data elements and definitions from published guidelines, clinical trials, databases, and standardized documents, then determined the data elements and standardized definitions, which should be included in CardiaCare. The writing committee also considered the specific domestic clinical management strategies during the establishment of Cardiacare. The resulting documents provide a series of key data elements and standardized definitions used in the management of coronary artery disease patients. Key data elements from CardiaCare could be sorted by clinical management flowsheet and outcome from hospitalization to long-term follow-up. Results: The Cardiacare standardized set comprised 864 data elements from admission to post-hospital follow-up visit. There were 8 tables in the documents, including demographic and admission information (23 elements), medical history and risk factors (102 elements), clinical presentations and diagnosis (22 elements), diagnostic and laboratory tests (111 elements), interventional diagnosis and treatment (118 elements), pharmacological therapy (213 elements), clinical outcomes (161 elements), and special subpopulations (114 elements: 87 elements for transcatheter valve replacement and 27 elements with cardiac rehabilitation). Conclusions: The Cardiacare standardized data elements set could provide support for real-world clinical research in consecutive data collection and databases mining. A wider applicability in various settings of CardiaCare needs to be explored further.
Cardiac Rehabilitation ; Coronary Artery Disease/drug therapy* ; Fibrinolytic Agents ; Humans

Aim To investigate the protective effect of hesperidin (HSD) on the injury of mouse pancreatic beta cells induced by high glucose and fatty acid and the underlying mechanism. Methods MIN6 cells were treated with high glucose and fatty acid after pretreatment of HSD. Cell counting kit-8 (CCK-8) and Hoechst 33258 fluorescence staining were used to determine the proliferation and apoptosis of MIN6 cells. Western blot was used to detect the expressions of apoptosis-related proteins Bcl-2 and Bax. RT-PCR was used to detect the expressions of inflammatory factors tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β). ELISA was used to test the insulin secretion of pancreatic islets. Results High glucose and fatty acid decreased the ratio of Bcl-2/Bax, increased the expression of inflammatory factors TNF-α and IL-1β and inhibited the insulin secretion of mouse pancreatic islets. After pretreatment of HSD, the cell viability and Bcl-2/Bax ratio of MIN6 increased, the expressions of inflammatory factors TNF-α and IL-1β decreased, and the insulin secretion of mouse pancreatic islets increased. Conclusions HSD could resist the apoptosis of mouse pancreatic islet B cell line MIN6 induced by high fat and high glucose, reduce the secretion of inflammatory factors and improve the insulin secretion of pancreatic islets.

Aim To explore the anti-inflammatory effect of taurolithocholic acid (TLCA) through network pharmacology-based analyses, to verify with in vitro macrophage study and to reveal the possible mechanisms. Methods The potential targets of TLCA were acquired from public database, and then the protein-protein interaction (PPI) networks against inflammation were constructed and visualized by using Cytoscape. Gene ontology (GO) analyses and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment were performed. The binding activity of TLCA and its target (TGR5) was evaluated through molecular docking analysis. Lastly, the results of the network analysis were confirmed by lipopolysaccharide and interferon-γ induced RAW264.7 cells. Results There were 87 anti-inflammatory potential targets were screened. GO analysis revealed gene functions were mainly involved in regulation of inflammatory response, membrane raft and protein tyrosine kinase. The results of KEGG pathway analysis suggested that PI3K-Akt signaling pathway, human cytomegalovirus infection might be the critical pathways of TLCA against inflammation. The results of in vitro experiments showed that TLCA decreased the LPS and IFN-γ induced inflammatory response in RAW 264.7 macrophages. Furthermore, the expression of TGR5 protein increased after TLCA treatment. Conclusions The potential therapeutic targets of TLCA against inflammation are revealed through network pharmacology analysis. Our results indicate that TLCA might regulate key inflammatory markers through the membrane receptor TGR5.

Andrographis Herba is a commonly used plant medicine, and has been recorded in pharmacopeias of different countries. However, there are some differences in the quality standards. Based on this, this paper compare the quality standards of Andrographis Herba between Chinese Pharmacopoeia, Hong Kong Chinese Materia Medica Standards, United States Pharmacopoeia, European Pharmacopoeia and Indian Pharmacopoeia, including origin, botanical characteristics, identification(microscopic identification and chromatographic identification), content determination, specific test(such as impurities, loss on drying, extractives, pesticides, heavy metals, mycotoxins, and other items) and storage requirements, so as to provide a reference for studying international quality standards of Andrographis.
Andrographis ; Drugs, Chinese Herbal ; Materia Medica ; Reference Standards

Lipids have been documented to play comprehensive and significant role in many biological processes. As a branch of metabolomics,lipidomics research mainly involves the analysis of the variation of lipid metabolism profiles under different physiologic,pathologic conditions or drug intervention,the discovery of key lipid biomarkers of a disease in lipid metabolic networks,and the study of the mechanism of action of lipid metabolic regulation during disease onset and progression,and drug treatment. Traditional Chinese medicines( TCMs)are characterized with integrated effects by multi-components,multi-targets and integrated effects. It is urgent to develop methods suitable for the study of complex TCMs to reveal the active constituents and integrated mechanism of action. Systems biology such as lipidomics provides valuable strategy and approach to illustrate the complex mechanisms of TCMs. In this paper,in order to provide technical references for TCMs,we have reviewed the analytical techniques applied in lipidomics and the applications of lipidomics in TCMs researches.
Biomarkers ; Lipid Metabolism ; Medicine, Chinese Traditional ; Metabolomics ; methods

Radix Semiaquilegiae(Tiankuizi in Chinese),the root of Semiaquilegia adoxoides,has been widely used in China,according to the traditional Chinese medicine(TCM)principle,it has effect of heat clearing and detoxicating,detumes-cence,lump dissipation.The main components of Radix Semiaquilegiae are alkaloids,cyano compounds and nitro com-pounds,phenolic acids.This review summarizes the achievements of the investigations in phytochemistry on Radix Semiaqui-legiae in order to provide reference for further study.

Objective To investigate the therapeutic methods of hyperpotassemia induced by excessively high blood concentration of tacrolimus (FK506) caused by drug use after renal transplantation. Methods Clinical data of 10 patients diagnosed with hyperpotassemia induced by excessively high blood concentration of FK506 after administration of antifunga l medication following renal transplantation were collected and retrospectively analyzed. Results At 1-2 months after renal transplantation, 10 patients suffered from pulmonary infectiono r pneumonia complicated with pulmonary fungal infection . An appropriate dose of compound sulfamethoxazole, micafungin, cefoperazone sodium-sulbactam sodium and moxifloxacin was administered for antifungal infection. After potassium-lowering therapy, termination of antifungal medication and FK506 dose adjustment (replaced by cyclosporin for certain cases), the serum level of potassium was declined and maintained within normal range for 10 cases. The serum concentration of FK506 was within normal range. No sign of excessively high level of potassium was observed without any potassium-lowering intervention. Conclusions Postoperative administration of drugs is likely to cause excessively high level of FK506 and hyperpotasesmia. Potassium-lowering therapy, termination of drug use and adjustment of immunosuppressive agents should be adopted to avoid the incidence of adverse pharmacologic interaction.