Clinical features of hepatic manifestations among adult patients with hemophagocytic lymphohistiocytosis: a retrospective study.

INTRODUCTION Liver dysfunction is common in patients with hemophagocytic lymphohistiocytosis (HLH). However, whether the severity of liver injury is associated with the prognosis of patients with HLH remains to be determined. This study aims to assess the association of the severity of liver involvement with short-term prognosis among adult patients with HLH. METHODS A retrospective study was performed from January 2012 to December 2020, including 150 patients with newly diagnosed HLH and liver injury. RESULTS The majority of our cohort suffered from mild to moderate hepatic damage, presenting with Child-Turcotte-Pugh (CTP) class A (55, 36.7%) or B (74, 49.3%). The prevalence of acute liver failure (ALF) was 9.3% in our cohort. The overall 30-day mortality rate was 49.3% among the study population. HLH patients with ALF showed an extremely adverse prognosis, with a mortality rate as high as 92.9%. In a multivariate analysis, age ≥ 60 years (p = 0.016), BUN ≥ 7 µmol/L (p < 0.001) and malignancy-associated HLH (p < 0.001) at the diagnosis of HLH were identified as being strongly correlated with 30-day prognosis. An excellent predictive power was found. Among the predictive scores used to assess early death of HLH patients with liver injury, the prognostic efficiency of chronic liver failure-sequential organ failure assessment (CLIF-SOFA) (AUROC: 0.936 ± 0.0211) and SOFA score (0.901 ± 0.026) were significantly better than those of the APACHE II (p < 0.001), Model for end-stage liver disease score (p < 0.001) and CTP scores (p < 0.001). The CLIF-SOFA score was slightly better than the SOFA score (p = 0.068). CONCLUSION Patients with old age, elevated BUN and malignancy had inferior survival. CLIF-SOFA and SOFA enables a more accurate prediction of early death in HLH patients with liver injury than other liver-specific and general prognostic models.

The application and effect of predictive nursing in the prevention of accidental events during operations for SMI patients.

OBJECTIVE: To explore the status and influencing factors of job burnout among psychiatric nurses and provide a reference for hospital managers to carry out occupational and psychological interventions. METHODS: Between September 2021 and September 2022, the psychiatric nurses in Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital) were selected as research participants using convenience sampling. The Chinese version of the nursing burnout scale was used to investigate the psychiatric nurses in the hospital, and a multiple linear regression analysis was performed on the factors affecting job burnout. RESULTS: Among the 121 psychiatric nurses, 57.85 % had no or only mild job burnout, 36.36 % had mild to moderate job burnout and 5.79 % had severe job burnout. The one-way analysis of variance indicated that there were statistical differences in the scores in terms of marital status, educational background, working years, income, work departments and shifts (p < 0.05). The multiple linear regression analysis indicated that the main influencing factors of job burnout were working years and work department (p < 0.05). CONCLUSION: The detection rate of nurses' job burnout in the featured psychiatric hospital was 42.10 %. The main influencing factors of job burnout were working years and work department, and targeted intervention can be carried out according to these two factors.

Intravital lipid droplet labeling and imaging reveals the phenotypes and functions of individual macrophages in vivo.

Macrophages play pivotal roles in the maintenance of tissue homeostasis. However, the reactivation of macrophages toward proinflammatory states correlates with a plethora of inflammatory diseases, including atherosclerosis, obesity, neurodegeneration, and bone marrow (BM) failure syndromes. The lack of methods to reveal macrophage phenotype and function in vivo impedes the translational research of these diseases. Here, we found that proinflammatory macrophages accumulate intracellular lipid droplets (LDs) relative to resting or noninflammatory macrophages both in vitro and in vivo, indicating that LD accumulation serves as a structural biomarker for macrophage phenotyping. To realize the staining and imaging of macrophage LDs in vivo, we developed a fluorescent fatty acid analog-loaded poly(lactic-co-glycolic acid) nanoparticle to label macrophages in mice with high efficiency and specificity. Using these novel nanoparticles, we achieved in situ functional identification of single macrophages in BM, liver, lung, and adipose tissues under conditions of acute or chronic inflammation. Moreover, with this intravital imaging platform, we further realized in vivo phenotyping of individual macrophages in the calvarial BM of mice under systemic inflammation. In conclusion, we established an efficient in vivo LD labeling and imaging system for single macrophage phenotyping, which will aid in the development of diagnostics and therapeutic monitoring. Moreover, this method also provides new avenues for the study of lipid trafficking and dynamics in vivo.

PEDF reduces malignant cells proliferation and inhibits the progression of myelofibrosis in myeloproliferative neoplasms.

Pigment epithelial-derived factor (PEDF) exerts a broad spectrum of activities and has been implicated in diverse biological processes and a variety of diseases. However, the role of PEDF in myeloproliferative neoplasms (MPN) remains unknown. In this study, we found that PEDF expression was down-regulated in MPN patients and MPLW515L-transuduced mice. Exogenous PEDF inhibited the peripheral blood cell proliferation in MPLW515L-transuduced mice, reduced tumor cells in bone marrow and spleen, ameliorated hepatosplenomegaly, reduced extramedullary hemopoiesis in the spleen, and prolonged the overall survival of MPN mice. More importantly, PEDF inhibited the progression of myelofibrosis. Moreover, PEDF significantly reduced the proliferation of MPN cells in vitro, especially megakaryocyte-biased HSCs. Furthermore, PEDF induced the apoptosis of MPN cells and reduced the secretion of TGF-ß1 in cell culture supernatant. Exogenous PEDF inhibits the proliferation of MPN cells and the progression of myelofibrosis, indicating that it might play an anti-tumor and anti-fibrotic role in MPN. This study implies that PEDF might be a novel agent for the treatment of MPN.

EPC infusion ameliorates acute graft-versus-host disease-related endothelial injury after allogeneic bone marrow transplantation.

Introduction: Graft-versus-host disease (GVHD) damages vascular endothelium. Endothelial progenitor cell (EPC) can differentiate to endothelial cell and promote angiogenesis, but its role in endothelial damage in GVHD is unclear. Methods: In this study, we intend to assess whether EPC infusion promotes the repair of endothelial injury in GVHD mouse model. Male BALB/c mice were randomly divided into 5 groups: control group, total body irradiation group (TBI group), allogeneic bone marrow transplantation group (Allo-BMT group), acute graft versus host disease group (GVHD group), EPC infusion group (GVHD+EPC group) followed by analysis of mice survival, acute GVHD (aGVHD) score, T cell infiltration by immunofluorescence, as well as continuity of vascular endothelium in liver. Results: Compared with Allo-BMT group, the clinical and pathological score of aGVHD mice were higher. On day 21 after transplantation, a large number of mononuclear cell infiltrations were seen in the target tissues of aGVHD mice and mice died within 30 days. In addition, aGVHD group also presented increased subendothelial infiltration of CD3+ T cells in the liver, decreased VE-cadherin expression and elevated major histocompatibility complex (MHC) II molecule expression in the endothelium. Moreover, expression of MHC-II molecule increased in endothelial cell after irradiation injury and LPS stimulation, indicating abnormally activated endothelial cell with antigen-presenting function. Interestingly, infusion of EPC reduced the clinical and pathological score of aGVHD, decreased infiltration of mononuclear cells, improved survival as well as upregulated VE-cadherin and downregulated MHC-II molecule. Discussion: EPC infusion can mobilize to affected endothelium to decrease the infiltration of T cells and pathological endothelial activation contributing to ameliorating the damage of endothelium. EPC infusion combined with bone marrow transplantation might be a perspective strategy for the prevention and treatment of aGVHD.

Dimethyl fumarate inhibits antibody-induced platelet destruction in immune thrombocytopenia mouse.

BACKGROUND: Immune thrombocytopenia (ITP) is an autoimmune disease characterized as a low platelet count resulting from immune-mediated platelet destruction. Dimethyl fumarate (DMF) is widely applied for the treatment of several autoimmune diseases with immunosuppressive effect. However, whether it ameliorates ITP is unclear. This study aims to evaluate whether DMF has a preventive effect on ITP in mice. METHODS: DMF (30, 60 or 90 mg/kg body weight) was intraperitoneally injected into mice followed by injection of rat anti-mouse integrin GPIIb/CD41antibody to induce ITP. Peripheral blood was isolated to measure platelet count and spleen mononuclear cells were extracted to measure Th1 and Treg cells along with detecting the levels of IFN-γ, and TGFß-1 in plasma and CD68 expression in spleen by immuohistochemical staining. Additionally, macrophage cell line RAW264.7 was cultured and treated with DMF followed by analysis of cell apoptosis and cycle, and the expression of FcγRI, FcγRIIb and FcγRIV mRNA. RESULTS: DMF significantly inhibited antiplatelet antibody-induced platelet destruction, decreased Th1 cells and the expression of T-bet and IFN-γ, upregulated Treg cells and the expression of Foxp3 and TGF-ß1 as well as reduced CD68 expression in the spleen of ITP mouse. DMF-treated RAW264.7 cells showed S-phase arrest, increased apoptosis and downregulated expression of FcγRI and FcγRIV. Meanwhile, in vitro treatment of DMF also decreased the expression of cyclin D1 and E2, reduced Bcl-2 level and increased Bax expression and caspase-3 activation. CONCLUSIONS: In conclusion, DMF prevents antibody-mediated platelet destruction in ITP mice possibly through promoting apoptosis, indicating that it might be used as a new approach for the treatment of ITP.

Nelfinavir restricts A549 cell growth by inhibiting STAT3 signaling.

OBJECTIVE: To investigate the anticancer effect of nelfinavir (NFV) on human A549 cells. METHODS: The inhibitory effects of NFV on the proliferation of human A549 cells were assessed using a MTT assay. Apoptotic cells were observed by fluorescence microscopy following Hoechst 33342 staining. Apoptosis of A549 cells was assessed using Annexin-V/propidium iodide staining and flow cytometry. Expression levels of signal transducer and activator of transcription 3 (STAT3) and p-STAT3 were measured by western blotting. STAT3 RNA silencing was used to investigate the pro-apoptotic mechanism of NFV in A549 cells. RESULTS: NFV dose-dependently suppressed proliferation of human A549 cells and induced significant apoptosis. Western blotting showed that the antitumor function of NFV might be mediated by STAT3 inhibition. A549 cell apoptosis in response to 20 µM NFV was significantly increased following STAT3 silencing. NFV significantly impeded the expression of the anti-apoptotic proteins Bcl-xL and Bcl-2, by increased the expression of the pro-apoptotic protein Cle-PARP. CONCLUSIONS: Our findings highlight STAT3 as a promising therapeutic target. NFV is a novel anti-cancer drug for the treatment of non-small-cell lung cancer.

Attention-Guided Deep Neural Network With Multi-Scale Feature Fusion for Liver Vessel Segmentation.

Liver vessel segmentation is fast becoming a key instrument in the diagnosis and surgical planning of liver diseases. In clinical practice, liver vessels are normally manual annotated by clinicians on each slice of CT images, which is extremely laborious. Several deep learning methods exist for liver vessel segmentation, however, promoting the performance of segmentation remains a major challenge due to the large variations and complex structure of liver vessels. Previous methods mainly using existing UNet architecture, but not all features of the encoder are useful for segmentation and some even cause interferences. To overcome this problem, we propose a novel deep neural network for liver vessel segmentation, called LVSNet, which employs special designs to obtain the accurate structure of the liver vessel. Specifically, we design Attention-Guided Concatenation (AGC) module to adaptively select the useful context features from low-level features guided by high-level features. The proposed AGC module focuses on capturing rich complemented information to obtain more details. In addition, we introduce an innovative multi-scale fusion block by constructing hierarchical residual-like connections within one single residual block, which is of great importance for effectively linking the local blood vessel fragments together. Furthermore, we construct a new dataset containing 40 thin thickness cases (0.625 mm) which consist of CT volumes and annotated vessels. To evaluate the effectiveness of the method with minor vessels, we also propose an automatic stratification method to split major and minor liver vessels. Extensive experimental results demonstrate that the proposed LVSNet outperforms previous methods on liver vessel segmentation datasets. Additionally, we conduct a series of ablation studies that comprehensively support the superiority of the underlying concepts.

AI-assisted CT imaging analysis for COVID-19 screening: Building and deploying a medical AI system.

The sudden outbreak of novel coronavirus 2019 (COVID-19) increased the diagnostic burden of radiologists. In the time of an epidemic crisis, we hope artificial intelligence (AI) to reduce physician workload in regions with the outbreak, and improve the diagnosis accuracy for physicians before they could acquire enough experience with the new disease. In this paper, we present our experience in building and deploying an AI system that automatically analyzes CT images and provides the probability of infection to rapidly detect COVID-19 pneumonia. The proposed system which consists of classification and segmentation will save about 30%-40% of the detection time for physicians and promote the performance of COVID-19 detection. Specifically, working in an interdisciplinary team of over 30 people with medical and/or AI background, geographically distributed in Beijing and Wuhan, we are able to overcome a series of challenges (e.g. data discrepancy, testing time-effectiveness of model, data security, etc.) in this particular situation and deploy the system in four weeks. In addition, since the proposed AI system provides the priority of each CT image with probability of infection, the physicians can confirm and segregate the infected patients in time. Using 1,136 training cases (723 positives for COVID-19) from five hospitals, we are able to achieve a sensitivity of 0.974 and specificity of 0.922 on the test dataset, which included a variety of pulmonary diseases.

Understanding the Morphology of High-Performance Solar Cells Based on a Low-Cost Polymer Donor.

A low-cost and high-performance bulk heterojunction (BHJ) solar cell comprising an emerging polymer donor, poly[(thiophene)-alt-(6,7-difluoro-2-(2-hexyldecyloxy)quinoxaline)] (PTQ10), shows an efficiency of 12.7%. To improve the performance of the solar cells, a better understanding of the structure-property relationships of the PTQ10-based devices is crucial. Here, we fabricate PTQ10/nonfullerene and fullerene BHJ devices, including PTQ10/IDIC, PTQ10/ITIC, and PTQ10/PC71BM, processed with or without thermal annealing and additive and provide detailed descriptions of the relationships between the morphology and performance. PTQ10 is found to be highly miscible with nonfullerene IDIC and ITIC acceptors and poorly miscible with fullerene PC71BM acceptors. Thermal annealing promotes the crystallization of PTQ10 and phase separation of all PTQ10/IDIC, PTQ10/ITIC, and PTQ10/PC71BM devices, leading to an increased power conversion efficiencies (PCEs) of the PTQ10/IDIC and PTQ10/ITIC devices but a decreased PCE of PTQ10/PC71BM devices with 1,8-di-iodooctane (DIO) additive. Without thermal annealing, DIO greatly improves the morphology of PTQ10/PC71BM, leading to a higher PCE. The results show that the degree of phase separation and ordering in the PTQ10-based devices significantly influences device performance. The morphology-property correlations demonstrated will assist in the rational design of these low-cost polymer donor-based solar cells to achieve even higher performance.

Preparation of the Auricularia auricular polysaccharides simulated hydrolysates and their hypoglycaemic effect.

The anti-diabetic effect of the Auricularia auricular polysaccharides simulated hydrolysates (APSHs) obtained from the dried fruiting body of Auricularia auricular was studied in this paper. The APSHs were administered intragastrically (i.g.) at the dose of 0.15g/kg b.w. to the streptozotocin (STZ) -induced diabetic male SD rats for 7 weeks. The results showed that fasting blood glucose level was significantly reduced (p<0.05), whereas the glucose tolerance was remarkable improvement in STZ-induced diabetic rats through APSHs administration, and loss in body weight was also prevented in diabetic mice (p<0.05). Moreover, APSHs could increase hepatic glycogen and pancreatic insulin level (p<0.01), as well as decrease the levels of serum TG and LDL-C compared to the diabetic control group (p<0.05). APSHs had no significant effects on the total cholesterol and HDL-C levels. APSHs were composed of arabinose, xylose, mannose, glucose, galactose and glucosamine with the molar ratio of 1.91:0.52:2.89:1.00:0.67:0.23. These studies suggest that APSHs exerts marked antidiabetic effect in experimental diabetes mellitus, thus justifying the potential treatment for diabetic mellitus.

Gold nanoparticles coated with polysarcosine brushes to enhance their colloidal stability and circulation time in vivo.

Polysarcosine (PS), a non-ionic hydrophilic polypeptoid whose structure is similar to polypeptides, bearing repeating units of natural α-amino acid, has been used to stabilize gold nanoparticles (AuNPs) due to its excellent hydrophilicity and biocompatibility. Disulfide functionalized polysarcosines with different molecular weight were synthesized and used to cap AuNPs by traditional ligand exchange. The grafting of PS on AuNPs was evidenced by Fourier transform infrared (FTIR) spectroscopy and the alternation of surface zeta potential. The polysarcosine coated AuNPs (Au@PS) showed good stabilities in wide pH range and saline condition. They had strong resistance to ligand competition of dithiothreitol (DTT). They showed good stability in serum, with a molecular weight dependent interaction pattern with proteins. The Au@PS had very low cytotoxicity and cell uptake in vitro. Based on the results in vitro, polysarcosine with molecular weight of 5kD with the best ability to stabilize AuNPs was used for in vivo test. The Au@PS had a longer circulation time in blood after intravenous injection than that of Au@PEG, indicating a better stealth-like property of polysarcosine. The Au@PS did not cause obvious toxicity in vivo, suggesting potential applications in disease diagnosis and therapy.