The influence of coronavirus disease 2019 on emergency department visits in Nanjing, China: A multicentre cross-sectional study.

INTRODUCTION: Influenza has been linked to the crowding in emergency departments (ED) across the world. The impact of the Coronavirus Disease 2019 (COVID-19) pandemic on China EDs has been quite different from those during past influenza outbreaks. Our objective was to determine if COVID-19 changed ED visit disease severity during the pandemic. METHODS: This was a retrospective cross sectional study conducted in Nanjing, China. We captured ED visit data from 28 hospitals. We then compared visit numbers from October 2019 to February 2020 for a month-to-month analysis and every February from 2017 to 2020 for a year-to-year analysis. Inter-group chi-square test and time series trend tests were performed to compare visit numbers. The primary outcome was the proportion of severe disease visits in the EDs. RESULTS: Through February 29 th 2020, there were 93 laboratory-confirmed COVID-19 patients in Nanjing, of which 40 cases (43.01%) were first seen in the ED. The total number of ED visits in Nanjing in February 2020, were dramatically decreased (n = 99,949) in compared to January 2020 (n = 313,125) and February 2019 (n = 262,503). Except for poisoning, the severe diseases in EDs all decreased in absolute number, but increased in proportion both in year-to-year and month-to-month analyses. This increase in proportional ED disease severity was greater in higher-level referral hospitals when compared year by year. CONCLUSION: The COVID-19 outbreak has been associated with decreases in ED visits in Nanjing, China, but increases in the proportion of severe ED visits.

15d-prostaglandin J2 protects cortical neurons against oxygen-glucose deprivation/reoxygenation injury: involvement of inhibiting autophagy through upregulation of Bcl-2.

We have previously shown that PPAR-γ agonist 15d-PGJ2 inhibited neuronal autophagy after cerebral ischemia/reperfusion injury. However, the underlying mechanism of its regulatory role in neuronal autophagy remains unclear. This study was designed to test the hypothesis that 15d-PGJ2 upregulated Bcl-2 which binds to Beclin 1, and thereby inhibits autophagy. We performed cell viability assay, cytotoxicity assay, western blot, and co-immunoprecipitation to analyze autophagy activities in vitro model of oxygen-glucose deprivation/reoxygenation (OGD/R). OGD/R induced autophagy in cultured cortical neurons. 15d-PGJ2 treatment significantly decreased LC3-II/LC3-I ratio and Beclin 1 expression, but increased p62 expression. Autophagic inhibitor 3-methyladenine decreased LC3-II levels, increased neuronal cell viability, and mimicked some protective effect of 15d-PGJ2 against OGD/R injury. OGD/R-induced autophagy coincided with decreases in Bcl-2 expression and increases in Beclin 1 expression. 15d-PGJ2 treatment upregulated Bcl-2 expression and decreased Beclin 1 expression, and inhibit the dissociation of Beclin1 from Bcl-2 significantly. Bcl-2 siRNA abrogated the effect of 15d-PGJ2 on Beclin 1, LC3-II and p62, and influence cell viability and LDH level, while scRNA did not. PPAR-γ agonist 15d-PGJ2 exerts neuroprotection partially via inhibiting neuronal autophagy after OGD/R injury. The inhibition of autophagy by 15d-PGJ2 is mediated through upregulation of Bcl-2.

Serum Mrp 8/14 as a Potential Biomarker for Predicting the Occurrence of Acute Respiratory Distress Syndrome Induced by Sepsis: A Retrospective Controlled Study.

Background: To date, there are no studies regarding the Mrp 8/14 in predicting the occurrence of acute respiratory distress syndrome (ARDS) induced by sepsis. Thus, the objective of this study was to investigate the expression of Myeloid-related proteins 8 and 14 (Mrp 8/14) and its role in ARDS induced by sepsis. Methods: A total of 168 septic patients were enrolled in the observational study. The baseline information and clinical outcomes were obtained retrospectively. Serum Mrp 8/14 level was determined by enzyme linked immunosorbent assay (ELISA). The patients were categorized into sepsis and ARDS group based on whether they developed ARDS during the intensive care unit (ICU) hospitalization. Results: There was significant difference in the level of Mrp 8/14 between the sepsis group and ARDS groups (P < 0.05). Mrp 8/14 correlated positively with procalcitonin (PCT), interleukin-6 (IL-6), acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score on day 1, mechanical ventilation time, length of ICU stay and hospitalization expenses in ICU (all P < 0.05). Logistic regression analysis showed Mrp 8/14 was the independent factor for forecasting the occurrence of sepsis- induced ARDS (P < 0.05). The areas under receiver operating characteristic curves for Mrp 8/14 were higher than that of PCT, APACHE II score and SOFA score on day 1 (P < 0.05). Conclusion: The serum Mrp 8/14 level at admission may be a potential marker for predicting the occurrence of ARDS induced by sepsis. Early detection of serum Mrp 8/14 could help clinicians to identify and evaluate the severity of ARDS induced by sepsis.

Diagnostic and prognostic values of immunocyte ratios in patients with sepsis in the intensive care unit.

INTRODUCTION: The aim of this study was to evaluate the diagnostic and prognostic values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), monocyte-to-lymphocyte ratio (MLR), neutrophils-to-lymphocytes and platelets ratio (N/LPR), mean platelet volume-to-platelet count ratio (MPV/PC), red blood cell distribution width-to-platelet count ratio (RDW/PC), and platelet volume distribution width-to-platelet count ratio (PDW/PC) in patients with sepsis. METHODOLOGY: A total of 203 patients with sepsis admitted to an emergent intensive care unit (EICU) were enrolled in this retrospective study. Basic data, inflammatory factors, NLR, PLR, PNR, MLR, N/LPR, MPV/PC, RDW/PC, PDW/PC were compared between survival and non-survival groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic values. The univariate and multivariate regression analyses were used for constructing a prognostic model for sepsis. RESULTS: There were significant differences in acute physiology and chronic health evaluation (APACHEII) score, mechanical ventilation, use of vasopressors, acute kidney injury (AKI), continuous renal replacement therapy (CRRT), long-term antiplatelet drug use, lymphocyte, monocyte, hemoglobin, procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP)*PCT, and N/LPR. APACHE II had the highest diagnostic value [Area Under Curve (AUC) = 0.999], followed by CRP*PCT (AUC = 0.718). The prognoses were different between patients stratified according to CRP, IL-6, lactic acid (Lac), PNR, PLR, PDW/PC, and APACHEII. Lac, CRP*PCT, PDW/PC, MPV/PC and APACHE II were independent prognostic factors of sepsis. CONCLUSIONS: Both N/LPR and CRP*PCT had high values to predict mortality in sepsis patients. CRP*PCT, PDW/PC and MPV/PC were independent factors to predict the prognosis of sepsis.

Detection of V. vulnificus septic shock with ARDS using mNGS.

The latest surveillance from the Centers for Disease Control and Prevention shows that the annual incidence of V. vulnificus infection is increasing. Unfortunately, in less well-known high-risk groups, this infection is usually excluded from differential diagnosis. Transmitted through wound exposure or ingestion, the mortality rate of foodborne diseases of V. vulnificus is the highest of all V. vulnificus. V. vulnificus is as lethal early diagnosis as Ebola and bubonic plague, so timely treatment is imperative. Sepsis caused by V. vulnificus infection mainly exists in the United States and is rarely reported in Southeast Asia. We report a 78-year-old man who went to the local hospital and complained of swelling in his right hand with severe pain. He ate raw salmon 2 days ago and denied other recognized seafood stab or trauma history and other seafood contact history. He was in septic shock at the time of treatment, so we immediately transferred to the emergency intensive care unit and tested for metagenomic next-generation sequencing (mNGS). The diagnosis was confirmed the second day after admission, and eventually he was cured and discharged from the hospital only after medical treatment, thus avoiding the risk of surgical debridement or even amputation. mNGS is helpful for early clinical diagnosis and effective early intervention for etiology, so that patients can get a good prognosis.

Prognostic significance of thyroid hormone T3 in patients with septic shock: a retrospective cohort study.

Background: The role of thyroid hormones is crucial in the response to stress and critical illness, which has been reported to be closely associated with a poor prognosis in patients admitted to the intensive care unit (ICU). This study aimed to explore the relationship between thyroid hormone and prognosis in septic shock patients. Methods: A total of 186 patients with septic shock were enrolled in the analytical study between December 2014 and September 2022. The baseline variables and thyroid hormone were collected. The patients were divided into survivor group and non-survivor group according to whether they died during the ICU hospitalization. Among 186 patients with septic shock, 123 (66.13%) were in the survivor group and 63 (33.87%) were in the non-survivor group. Results: There were significant differences in the indictors of free triiodothyronine (FT3) (p = 0.000), triiodothyronine (T3) (p = 0.000), T3/FT3 (p = 0.000), acute physiology and chronic health evaluation II score (APACHE II) (p = 0.000), sequential organ failure assessment score (SOFA) (p = 0.000), pulse rate (p = 0.020), creatinine (p = 0.008), PaO2/FiO2 (p = 0.000), length of stay (p = 0.000) and hospitalization expenses (p = 0.000) in ICU between the two groups. FT3 [odds ratio (OR): 1.062, 95% confidence interval(CI): (0.021, 0.447), p = 0.003], T3 (OR: 0.291, 95% CI: 0.172-0.975, p = 0.037) and T3/FT3 (OR: 0.985, 95% CI:0.974-0.996, p = 0.006) were independent risk factors of the short-term prognosis of septic shock patients after adjustment. The areas under the receiver operating characteristic curves for T3 was associated with ICU mortality (AUC = 0.796, p < 0.05) and was higher than that for FT3 (AUC = 0.670, p < 0.05) and T3/FT3 (AUC = 0.712, p < 0.05). A Kaplan-Meier curve showed that patients with T3 greater than 0.48 nmol/L had a significantly higher survival rate than the patients with T3 less than 0.48 nmol/L. Conclusions: The decrease in serum level of T3 in patients with septic shock is associated with ICU mortality. Early detection of serum T3 level could help clinicians to identify septic shock patients at high risk of clinical deterioration.

[Protective effect of N-acetylcysteine against pneumocyte apoptosis during ischemia/reperfusion injury of lung in rats].

OBJECTIVE: To investigate the effect of N-acetylcysteine (NAC) on apoptosis of pneumocytes and expression of caspase-3 during lung ischemia/reperfusion injury (LIRI) in rats, and to explore the possible role of NAC in pneumocyte apoptosis. METHODS: Forty-two male Sprague-Dawley rats were randomly divided into three groups: sham operation group, LIRI group (LIRI was produced by 45 minutes of clamping of the pulmonary hilum followed by 3 hours or 6 hours of reperfusion), and NAC group (NAC 150 mg/kg was injected intraperitoneally before LIRI). Lung specimens were harvested 3 hours or 6 hours after LIRI. Apoptosis rate in lung tissue was determined with flow cytometer after Annexin V-fluorescein isothiocyanate (FITC) and propidium iodide (PI) staining. Malondialdehyde (MDA, thiobarbituric acid) and superoxide dismutase (SOD, xanthine oxidase) of lung tissue were measured. Expression of caspase-3 in lung was determined by reverse transcription-polymerase chain reaction (RT-PCR), and the changes in ultrastructure of lung tissue were observed by electron microscope. RESULTS: Compared with that of the sham operation group, apoptosis rate of pulmonary cells was significantly increased at 3 hours and 6 hours in LIRI group [(25.60 ± 3.22)% vs. (2.19 ± 0.48)% , (26.01 ± 4.50)% vs. (2.55 ± 0.36)%], the content of MDA (nmol/mg) was significantly increased (3.26 ± 0.32 vs. 0.73 ± 0.23, 3.53 ± 0.46 vs. 1.08 ± 0.42), and the activity of SOD (U/mg) was significantly lowered (32.80 ± 3.82 vs. 60.51 ± 6.81, 33.44 ± 3.24 vs. 64.19 ± 6.60), and the expression of caspase-3 mRNA in lung tissue was significantly up-regulated (0.717 ± 0.037 vs. 0.216 ± 0.046, 0.744 ± 0.046 vs. 0.227 ± 0.037, all P < 0.01). Compared with that of the LIRI group, apoptosis rate of pulmonary cell was significantly decreased [(14.42 ± 1.61)% vs. (25.60 ± 3.22)%, (10.02 ± 1.64)% vs. (26.01 ± 4.50)%], content of MDA (nmol/mg) was lowered significantly (1.75 ± 0.33 vs. 3.26 ± 0.32, 2.15 ± 0.25 vs. 3.53 ± 0.46), and activity of SOD (U/mg) was significantly elevated (42.76 ± 2.06 vs. 32.80 ± 3.82, 44.94 ± 3.11 vs. 33.44 ± 3.24, all P < 0.01) in NAC group. The expression of caspase-3 in lung tissue was remarkably down-regulated compared with that of LIRI group (0.441 ± 0.038 vs. 0.717 ± 0.037, 0.410 ± 0.037 vs. 0.744 ± 0.046, both P < 0.01). The ultrastructure changes in lung tissue were milder in NAC group than in LIRI group. Positive correlation was found between the expression of caspase-3 and apoptosis rate and the content of MDA (3 hours: r = 0.9036, 0.9216; 6 hours: r = 0.9655, 0.9650, all P < 0.01), but negative correlation was found between apoptosis rate and activity of SOD (3 hours: r = -0.9511, 6 hours: r = - 0.9574, both P < 0.01) after LIRI 3 hours and 6 hours. CONCLUSION: During early period of LIRI, caspase-3 was significantly deregulated by NAC, therefore the cellular apoptosis was inhibited, thus protecting lung tissue from LIRI.

Upregulation of peroxisome proliferator-activated receptor-gamma and NADPH oxidases are involved in restenosis after balloon injury.

Restenosis is a major complication of percutaneous transluminal coronary angioplasty (PTCA) and is characterized by increased superoxide formation and accumulation of smooth muscle cells (SMCs). The mechanisms through which peroxisome proliferator-activated receptor-gamma (PPAR-gamma) modulates the pathological process are incompletely defined. In this study, balloon injury of porcine coronary arteries in vivo and cell scraping model in vitro were used to elucidate the pathway via this molecule. PPAR-gamma and NADPH oxidase expression significantly increased both in neointimal hyperplasia after balloon injury or in the cultured SMCs after scraping injury. In vitro, PPAR-gamma agonist 15-deoxy-Delta(12,14)-prostagladlin J(2) (15d-PGJ2) decreased cell-scraping-induced superoxide generation through suppression of NADPH oxidase activity via down-regulation of p22(phox) and gp91(phox). Furthermore, 15d-PGJ2 could suppress scraping-stimulated proliferation of SMCs. These data demonstrate that upregulation of PPAR-gamma and NADPH oxidases are involved in restenosis and activation of PPAR-gamma can inhibit the NADPH oxidase-dependent superoxide generation in SMCs after injury. These findings will provide a new potential drug target for restenosis after balloon injury.

[Protective effect of methylprednisolone and Naloxone on pulmonary ischemia/reperfusion injury in rats].

OBJECTIVE: To investigate the effect of methylprednisolone (MP) and naloxone (Na) on pulmonary ischemia/reperfusion (I/R) injury in rats and to study its possible mechanism. METHODS: Seventy male Sprague-Dawley (SD) rats were used for reproduction of unilateral lung ischemia/reperfusion (I/R) injury, and they were randomly divided into five groups (14 rats in each group): sham operation group (sham group), I/R group, MP group,Na group, and MP+Na group. Each group was subdivided into two subgroups of 3-hour and 6-hour postinjury. I/R injury was produced by 45 minutes of cross-clamping of the pulmonary artery, followed by 3 hours or 6 hours of reperfusion. Apoptosis rate in lung tissue was assessed by the use of Annexin-V-PI with flow cytometry. Expression of I Kappa B-alpha and caspase-3 in lung tissue were observed by immunohistochemical stain and image analysis. The wet to dry weight (W/D) ratio, the pathological and ultrastructure changes in lung tissue were observed. RESULTS: (1) The expression of I Kappa B-alpha in lung was obviously lower in I/R group than in 6-hour MP group (P<0.01), while expression of caspase-3 in lung tissue was significantly less intense in 3-hour and 6-hour Na group compared with I/R group (both P<0.05). Apoptosis rate in lung tissue was obviously lower in MP and 3-hour and 6-hour Na group than in I/R group (both P<0.01). The pathological and ultrastructure changes in lung tissue were less intensive. (2) Apoptosis rate, caspase-3 of lung tissue were significantly lower in MP+Na group than of 6-hour in MP, Na, I/R groups (P<0.05 or P<0.01) while the expression of I Kappa B-alpha was higher than of 6-hour Na group. The pathological and ultrastructure change in lung tissue were less more mark in MP+Na group than in other groups. CONCLUSION: MP and Na inhibit apoptosis in lung I/R injury by either decreasing the activation of I Kappa B-alpha or caspase-3.MP and Na when used together in early period of lung I/R injury could exert more effective protection to lung tissue.

[Effect of early enriched parenteral alanyl-glutamine on heat shock protein 70 (HSP70) expression in critical patients].

OBJECTIVE: To evaluate the effect of early parenteral glutamine (Gln) administration on heat shock protein (HSP70) expression and clinical outcome in critical patients. METHODS: Forty-four Patients requiring parenteral nutrition (PN) for more than 7 days, admitted to emergency intensive care unit (EICU) and neurosurgical intensive care units (NICU) were randomly divided into two groups, one was the control group, the other was the Gln treatment group (each n=22). Patients in both group received PN and enteral nutrition (EN). In addition, glutamine 0.4 g/kg per day was given to patients of Gln treatment group for 7 days. Serum HSP70, Gln concentrations were measured at admission and 7 days after the nutritional supplementation. Observations of clinical outcome included the length of mechanical ventilation, the length of stay in intensive care unit (ICU), the incidence of liver and kidney dysfunction before and after treatment. RESULTS: Serum HSP70 and Gln level showed no significant changes in control group and Gln treatment group before the treatment (both P>0.05), though they were mildly increased after conventional treatment compared with the control group, but without statistically significant difference. In Gln treatment group, between serum HSP70, Gln concentrations were significantly higher than those before treatment (both P<0.01), and they showed significant difference between control group and Gln group after treatment (both P<0.01). HSP70 level was significantly positively correlated with Gln level in critical patients (r=0.650 5, P=0.001). The ratios of liver dysfunction and the length of mechanical ventilation showed significant difference between Gln group and control group (both P<0.05). The ratios of kidney dysfunction and the length of stay in ICU showed no obvious changes between two groups (both P>0.05). CONCLUSION: Early parenteral glutamine administration can improve clinical outcome, decrease the ratio of organ dysfunction possibly by the mechanism of increasing serum HSP70 in critical patients.

[Epidemiology characteristics of crawfish related rhabdomyolysis in Nanjing, 2016: a multicenter retrospective investigation].

OBJECTIVE: To investigate the epidemiology characteristics of crawfish related rhabdomyolysis (RM) in Nanjing, 2016. METHODS: Outpatient and inpatient electronic medical system of 21 hospitals in Nanjing during 2016 were retrospectively searched, and all the patients diagnosed with RM were selected. The patients with none crayfish-related RM was excluded. The epidemiology characteristics were depicted. The geographic information system (GIS) was used to collect, manage and analyze the spatial data, to visualize it, to analyze the spatial distribution features of the disease, and to explore the cause of disease prediction. GeoDa 1.8 software was used to analyze the global and local spatial auto-correlation. RESULTS: A total of 1 183 patients with crawfish related RM were initially screened, excluding 59 patients with RM caused by trauma, severe exercise, heat stroke, myositis, poisoning, drugs, and genetic diseases, and 1 124 patients were enrolled. The proportion of men was 36.48% (410/1 124) with an incidence of 12.54/100 thousands; while of women was 63.52% (714/1 124) with an incidence of 21.86/100 thousands. The median age at onset was 34 (28, 43) years. From July to August, the incidence of crawfish related RM was the highest, accounting for 96.53% of the total number of cases. The top four incidence areas were Pukou (41.54/100 thousands), Jianye (25.94/100 thousands), Qixia (25.73/100 thousands), Gulou (25.04/100 thousands), all of which were adjacent to the Yangtze River. Global spatial autocorrelation analysis showed: Moran I = 0.427, Z = 2.646, P = 0.003, suggesting that the crawfish related RM had positive spatial autocorrelation. The results showed that the spatial structure of crawfish related RM existed in Nanjing in 2016. Local spatial autocorrelation analysis showed that the "high-high" concentration areas were Pukou, Jianye and Liuhe. The incidences of above three areas which were the Nanjing section of the lower reaches of the Yangtze River flowed through the region and surrounding areas were higher than the overall incidence of Nanjing. CONCLUSIONS: The prevalence of crawfish related RM in Nanjing during 2016 had an obvious region-concentrated character and global spatial autocorrelation with the high prevalent regions mainly concentrated in the urban areas adjacent to the Yangtze River.

Effect of dobutamine on lung aquaporin 5 in endotoxine shock-induced acute lung injury rabbit.

BACKGROUND: Dobutamine, a commonly used vasoactive drug, has been reported to reduce pulmonary edema and protect against acute lung injury (ALI) by up-regulating aquaporin 5 (AQP5) expressions. However, the underlying mechanism is still elusive. METHODS: ALI was induced by intravenous injection of LPS. Seventy male New Zealand white rabbits were randomly divided into seven groups: sham group, ALI group, dobutamine low-dose group [group ALI + Dob (L)], dobutamine medium-dose group [group ALI + Dob (M)], dobutamine high-dose group [group ALI + Dob (H)], ALI + Dob (H) + ICI group and sham + ICI group. ICI 118,551, a potent and specific beta-2 antagonist, could block the effect of dobutamine. The animals were sacrificed at 3 h after endotoxic shock and lungs were removed. The arterial blood gas was analyzed. The lung wet to dry (W/D) ratio was determined. The level of cyclic AMP (cAMP) in lung tissue was assessed by ELISA. The expression of AQP5 protein was determined by western blotting and immunohistochemistry. The pathological alteration in lung tissue was evaluated by optical microscopy and electron microscope, and lung injury score was assessed. RESULTS: Dobutamine increased AQP5 protein expression and cAMP level in a dose-dependent manner. Meanwhile, the degree of lung pathological and ultrastructural lesion was ameliorated and arterial blood gas was improved obviously. Additionally, W/D ratio and histological scores decreased significantly. However, the AQP5 protein expression and cAMP level were significantly decreased in group ALI + Dob (H) + ICI than that in group ALI + Dob (H), the degree of lung pathological and ultrastructural lesion was more serious in group ALI + Dob (H) + ICI than that in group ALI + Dob (H) and the arterial blood gas was not obviously improved. CONCLUSIONS: These results suggested that protective effect of dobutamine against endotoxin shock-induced ALI may be due to its ability of up-regulating AQP5 protein expression via increasing intracellular cAMP concentration.

PET imaging of apoptosis in tumor-bearing mice and rabbits after paclitaxel treatment with (18)F(-)Labeled recombinant human His10-annexin V.

Monitoring response to chemo- or radiotherapy is of great importance in clinical practice. Apoptosis imaging serves as a very useful tool for the early evaluation of tumor response. The goal of this study was PET imaging of apoptosis with (18)F-labeled recombinant human annexin V linked with 10 histidine tag ((18)F-rh-His10-annexin V) in nude mice bearing an A549 tumor and rabbits bearing a VX2 lung cancer after paclitaxel therapy. (18)F-rh-His10-annexin V was prepared by conjugation of rh-His10-annexin V with N-succinimidyl 4-[(18)F]fluorobenzoate. Biodistribution was determined in mice by the dissection method and small-animal PET. Single-dose paclitaxel (175 mg/m(2)) was used to induce apoptosis in A549 and VX2 tumor models. (18)F-rh-His10-annexin V was injected into A549 mice and VX rabbits to acquire dynamic and static PET images 72 h after paclitaxel treatment. The uptake of (18)F-rh-His10-annexin V in apoptotic cells 4 h after induction was 6.45±0.52 fold higher than that in non-induced cells. High focal uptake of (18)F-rh-His10-annexin V was visualized in A549 (SUVmax: 0.35±0.13) and VX2 (0.41±0.23) tumor models after paclitaxel treatment, whereas lower uptake was found in the corresponding tumors before treatment (A549 SUVmax: 0.04±0.02; VX2: 0.009±0.002). The apoptotic index was 75.61±11.56% in the treated VX2 cancer, much higher than that in the untreated VX2 (8.03±2.81%). This study demonstrated the feasibility of (18)F-rh-His10-annexin V for the detection of apoptosis after chemotherapy in A549 and VX2 tumor models.

Ginkgolide B prevents cathepsin-mediated cell death following cerebral ischemia/reperfusion injury.

Ginkgolide B (GB) has been shown to exert neuroprotective effects against cerebral ischemia/reperfusion (I/R) injury. However, the underlying mechanism by which GB prevents ischemic cell death remains unclear. Lysosomal proteases, including cathepsins B and L, have been implicated in ischemic cell death following reperfusion. Therefore, in the present study, we investigated the role of GB with respect to cathepsin-mediated cell death following I/R. Both the expression and enzymatic activity of cathepsins B and L were significantly increased in the ischemic cortex following cerebral I/R injury. We found that GB treatment markedly decreased the activity and expression of cathepsins B and L following I/R. Moreover, GB reduced necrotic and apoptotic cell death following I/R. These data strongly suggest that GB prevents cathepsin-mediated cell death following focal cerebral I/R injury, and they might provide new insights into the mechanism of the neuroprotective effects of GB.

Protective effect of glutamine in critical patients with acute liver injury.

BACKGROUND: Glutamine (Gln) supplementation is known to decrease oxidative stress and inflammatory response, enhance resistance to infectious pathogens, shorten hospital stay, and decrease medical costs of patients. This study was undertaken to evaluate the relationship between the effect of early parenteral glutamine (Gln) supplement on acute liver injury (ALI) and heat shock protein 70 (HSP-70) expression in critical patients. METHODS: Forty-four patients who had been admitted to the emergency intensive care unit (EICU) of Nanjing First Hospital Affiliated to Nanjing Medical University were randomly divided into a control group (n=22) and a Gln group (n=22). The patients of the two groups received enteral and parenteral nutrition. In addition, parenteral Gln 0.4 g/kg per day was given for 7 days in the Gln group. Serum HSP-70 and Gln were measured at admission and at 7 days after admission. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBiL), serum levels of HSP-70 and Gln, mechanical ventilation (MV) time, ICU stay, peripheral blood of TNF-α, IL-6, CD3, CD4 and CD4/CD8 levels were also measured in the two groups. RESULTS: In the Gln group, the levels of serum HSP-70 and Gln were significantly higher after Gln treatment than those before the treatment (P<0.01). HSP-70 level was positively correlated with the Gln level in the Gln group after administration of parenteral Gln (P<0.01). The levels of serum ALT, AST, TBiL and TNF-α, IL-6 were lower in the Gln group than in the non-Gln group (P<0.01). MV time and ICU stay were significantly different between the two groups (P<0.05). The levels of CD3, CD4 and CD4/CD8 were significantly higher in the Gln group than in the control group after treatment (P<0.05). CONCLUSION: Parenteral Gln significantly increases the level of serum HSP70 in critically ill patients. The enhanced expression of HSP70 is correlated with improved outcomes of Gln-treated patients with acute liver injury.