Evaluation of the clinical efficacy of ultra-fast track anesthesia for endoscopic thoracic sympathectomy of palmar hyperhidrosis.

OBJECTIVE: In this study, we investigated the safety and practicability of ultra-fast track anesthesia (UFTA) for endoscopic thoracic sympathectomy (ETS). METHODS: A total of 72 patients with palmar hyperhidrosis undergoing ETS were randomly divided into three groups: the UFTA group (group I), the group undergoing single-lumen tracheal intubation with local infiltration anesthesia technique (group II), and the group undergoing single-lumen tracheal intubation with routine anesthesia (group III). Mean arterial pressure (MAP) and heart rate (HR) were recorded for all three groups at the following six time points: Before anesthetics administration (T0), the time of intubating or inserting laryngeal mask airway (T1), the time of incising skin (T2), the time of disconnecting of the right sympathetic nerve (T3), the time of disconnecting of the left sympathetic nerve (T4), the time of withdrawing the tracheal tube or laryngeal mask airway (T5), and the time of transferring the patient to a post-anesthesia care unit (PACU) (T6). The three groups were compared from the following perspectives: surgery duration; anesthesia recovery duration, that is, the duration from discontinuation of anesthesia to extubating the tracheal tube; the dose of propofol and remifentanil per kilogram body mass per unit time interval (the time at the end of the procedure, which lasted from anesthesia induction to incision suturing); and the visual analog scale (VAS) in the resting state in the PACU. RESULTS: Based on pairwise comparisons, the average HR and average MAP values of the three groups differed significantly from T2 to T6 (p < 0.05). As demonstrated by the correlation analysis between remifentanil and propofol with HR and MAP, the doses of the total amount of remifentanil and propofol were lower, and group I used less remifentanil and propofol than group II. No patient in group I experienced throat discomfort following surgery. Patients in groups II and III experienced a range of postoperative discomfort. The VAS scores of groups I and II were significantly lower than those of group III, with group I lower than group II. CONCLUSION: When utilized in ETS, UFTA can provide effective anesthesia for minor traumas. It is safe, effective, and consistent with the enhanced recovery philosophy of fast-track surgery departments.

Inflammatory myofibroblastic tumor of the heart in an older woman with paroxysmal atrial fibrillation: a case report and review of the literature.

Inflammatory myofibroblastic tumors (IMTs) of the heart are rarely observed in the eldly. We report a case involving an elderly woman with an IMT situated on the right atrial wall. The tumor was fully excised. The patient had a smooth recovery post-surgery and remained free of recurrence for three years.

Efficacy of Qingpeng ointment (a Tibetan medicine) for acute gouty arthritis: a multi-center, randomized, double-blind, placebo-controlled trial.

BACKGROUND: This study aims to assess the efficacy and safety of Qingpeng ointment (QPO), a Tibetan medicine for alleviating symptoms in individuals with acute gouty arthritis (AGA). METHODS: This study was a randomized, double-blind, placebo-controlled trial that involved individuals with AGA whose joint pain, as measured on a visual analog scale (VAS) from 0 to 10, was equal to or greater than 3. The participants were randomly assigned to either the QPO or the placebo group and received their respective treatments twice daily for seven consecutive days. In case of intolerable pain, the participants were allowed to use diclofenac sodium sustained-release tablets as a rescue medicine. The primary outcomes measured were joint pain and swelling, while the secondary outcomes included joint mobility, redness, serum uric acid levels, C-reactive protein levels, and the amount of remaining rescue medicine. Any adverse events that occurred during the trial were also recorded. RESULTS: A total of 203 cases were divided into two groups, with balanced baselines: 102 in the QPO group and 101 in the placebo group. For joint pain, differences between the groups were notable in the VAS scores [1.75 (0, 3.00) versus 2.00 (1.00, 3.50); P = 0.038], changes in VAS [5.00 (3.00, 6.00) versus 4.00 (2.00, 6.00); P = 0.036], and disappearance rate [26.47% compared to 15.84%; P = 0.046] after treatment. Concerning joint swelling, significant between-group differences were observed in the VAS scores [1.00 (0, 2.30) versus 2.00 (0.70, 3.00); P = 0.032] and disappearance rate [33.33% compared to 21.78%; P = 0.046] at treatment completion. The QPO group exhibited a statistically significant mobility improvement compared to the placebo group (P = 0.004). No significant differences were found in other secondary outcomes. Five patients, four from the QPO group and one from the other, encountered mild adverse events, primarily skin irritation. All of these cases were resolved after dosage reduction or discontinuation of the medication. CONCLUSIONS: Compared to the placebo, QPO exhibits positive effects on AGA by alleviating pain, reducing swelling, and enhancing joint mobility, without causing significant adverse effects. TRIAL REGISTRATION: ISRCTN34355813. Registered on 25/01/2021.

Facile In Situ Preparation and In Vitro Antibacterial Activity of PDMAEMA-Based Silver-Bearing Copolymer Micelles.

Well-defined polymer micelles with core-shell structure are good delivery platform for stabilizing silver nanoparticles (AgNPs) in the field of antimicrobials targeting diseases. The rational construction of the polymer structure, an efficient, facile, and green preparation approach, and comprehensive exploration of the derived AgNPs are necessary, such as size, particle stability, antibacterial activity, and other properties. Herein, we designed and assessed the in vitro antimicrobial activity of AgNPs-decorated copolymer micelles with different copolymer topologies. First, linear or four-arm star triblock copolymers with the similar molecular weight and degree of polymerization were obtained, which consisted of DMAEMA for in situ reduction of silver ions to form AgNPs without external reducing agent. HEMA and PEGMA in micellar shell gave an enhanced stability of AgNPs during blood circulation. The combination of computational modeling and experimental results indicated that both types of micelles could fabricate AgNPs with monodisperse and spherical morphology. Star copolymer micelles stabilized AgNPs had smaller average size, better stability, and higher antibacterial activity than those with linear structure, which may due to higher stability of micelles from star copolymers. Furthermore, the cytotoxicity evaluation test showed that the achieved linear or star copolymers micelles stabilized AgNPs had good biocompatibility. This work provides a facile and universal approach in the rational design of micelles stabilized AgNPs with suitable topology for fighting against a wide range of bacterial infections.

Design, expression, and characterization of a novel cecropin A-derived peptide with high antibacterial activity.

In recent years, antimicrobial peptides have received increased interest and are potential substitutes for antibiotics. However, natural antimicrobial peptides are always toxic to mammalian cells and usually exhibit weak antibacterial activity, which restrict their wide application. In this study, a novel antibacterial peptide named PEW300 was designed with three mutations to the parental peptide cecropin A. As predicted by bioinformatic programs, the positive charge of PEW300 increased from + 6 to + 9 compared with cecropin A, and the grand average of hydropathicity increased from - 0.084 to - 0.008. Expression of PEW300 resulted in serious inhibition of Escherichia coli BL21(DE3) cells, indicating designed PEW300 may have stronger antibacterial activity. A simple, fast, and low-cost approach without tedious protein purification steps was selected for the efficient production of PEW300 by fusion with ELK16 and about 7.38 µg/mg wet cell weight PEW300 was eventually obtained. Purified PEW300 exhibited strong antibacterial activity against various Gram-positive and Gram-negative bacteria which was enhanced four- to sevenfold compared with the parental peptide cecropin A. Besides, PEW300 had no hemolytic activity toward mammalian cells even at high concentration (224 ng/µl). PEW300 showed good stability in neutral and alkaline solutions. Moreover, PEW300 was thermally stable even at up to 100 °C and resistant to proteinase K, pepsin, snailase, and trypsin. The incubation with human serum had no effect on the antibacterial activity of PEW300. All these results demonstrated that PEW300 designed in this work may have good potential as a candidate pharmaceutical agent.

Rapid and efficient production of cecropin A antibacterial peptide in Escherichia coli by fusion with a self-aggregating protein.

BACKGROUND: Cecropin A (CeA), a natural cationic antimicrobial peptide, exerts potent antimicrobial activity against a broad spectrum of Gram-positive and Gram-negative bacteria, making it an attractive candidate substitute for antimicrobials. However, the low production rate and cumbersome, expensive processes required for both its recombinant and chemical synthesis have seriously hindered the exploitation and application of CeA. Here, we utilized a short ß-structured self-aggregating protein, ELK16, as a fusion partner of CeA, which allowed the efficient production of high-purity CeA antibacterial peptide with a simple inexpensive process. RESULTS: In this study, three different approaches to the production of CeA peptide were investigated: an affinity tag (His-tag)-fused protein expression system (AT-HIS system), a cell-free protein expression system (CF system), and a self-assembling peptide (ELK16)-fused protein expression system (SA-ELK16 system). In the AT-HIS and CF systems, the CeA peptide was obtained with purities of 92.1% and 90.4%, respectively, using one or more affinity-chromatographic purification steps. The procedures were tedious and costly, with CeA yields of only 0.41 and 0.93 µg/mg wet cell weight, respectively. Surprisingly, in the SA-ELK16 system, about 6.2 µg/mg wet cell weight of high-purity (approximately 99.8%) CeA peptide was obtained with a simple low-cost process including steps such as centrifugation and acetic acid treatment. An antimicrobial test showed that the high-purity CeA produced in this study had the same antimicrobial activity as synthetic CeA peptide. CONCLUSIONS: In this study, we designed a suitable expression system (SA-ELK16 system) for the production of the antibacterial peptide CeA and compared it with two other protein expression systems. A high yield of high-purity CeA peptide was obtained with the SA-ELK16 system, which greatly reduced the cost and time required for downstream processing. This system may provide a platform for the laboratory scale production of the CeA antibacterial peptide.

High Efficient Expression, Purification, and Functional Characterization of Native Human Epidermal Growth Factor in Escherichia coli.

Human epidermal growth factor (hEGF) is a small, mitotic growth polypeptide that promotes the proliferation of various cells and is widely applied in clinical practices. However, high efficient expression of native hEGF in Escherichia coli has not been successful, since three disulfide bonds in monomer hEGF made it unable to fold into correct 3D structure using in vivo system. To tackle this problem, we fused Mxe GyrA intein (Mxe) at the C-terminal of hEGF followed by small ubiquitin-related modifier (SUMO) and 10x His-tag to construct a chimeric protein hEGF-Mxe-SUMO-H10. The fusion protein was highly expressed at the concentration of 281 mg/L and up to 59.5% of the total cellular soluble proteins. The fusion protein was purified by affinity chromatography and 29.4 mg/L of native hEGF can be released by thiol induced N-terminal cleavage without any proteases. The mitotic activity in Balb/c 3T3 cells is proliferated by commercial and recombinant hEGF measured with methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay which indicated that recombinant hEGF protein stimulates the cell proliferation similar to commercial protein. This study significantly improved the yield and reduced the cost of hEGF in the recombinant E. coli system and could be a better strategy to produce native hEGF for pharmaceutical development.

[Correlation study between lupus nephritis patients of rheumatism syndrome and SLEDAI--a clinical study].

OBJECTIVE: To explore lupus nephritis (LN) patients' monocyte chemotactic protein 1 (MCP-1) and urinary IP-10 (ulP-10) levels, the correlation between each clinical activity index and rheumatism syndrome, thereby proving objective evidence for microscopic typing of rheumatism syndrome. METHODS: Totally 60 LN patients were assigned to the rheumatism group (31 cases) and the non-rheumatism group (29 cases). Besides, 20 healthy volunteers were recruited as the normal control group. Clinical data and renal pathology were collected, and urinary levels of MCP-1 and IP-10 detected by ELISA. The correlation between rheumatism syndrome and each activity index as well as manifestations of clinical activities was comprehensively analyzed. Results (1) Patients in the rheumatism group were more liable to occur fever, serositis, edema, and hypertension (P<0.05). (2) Compared with the non-rheumatism group, patients in the rheumatism group exhibited much higher levels of 24 h protein quantification and blood urea nitrogen, higher levels of uMCP-1 and ulP-10. Microscopic hematuria, anti-ds-DNA, anti-Sm, the positive rate of AnuA, scores of SLEDAI and BILAG were higher in the rheumatism group than in the non-rheumatism group (P<0.05). Levels of plasma albumin and complement C3 were lower in the rheumatism group than in the non-rheumatism group (P<0.05). (3) The average activity index (AI) of the renal pathology was higher in the rheumatism group than in the non-rheumatism group. The most frequent pathological type of rheumatism group was type IV of LN. CONCLUSIONS: More severe renal damage and immune abnormality occurred in LN patients of rheumatism syndrome. Rheumatism syndrome is closely correlated to clinical activity indices.