[Shenfu Injection alleviates sepsis-associated lung injury by regulating HIF-1α].

Shenfu Injection(SFI) is praised for the high efficacy in the treatment of septic shock. However, the precise role of SFI in the treatment of sepsis-associated lung injury is not fully understood. This study investigated the protective effect of SFI on sepsis-associated lung injury by a clinical trial and an animal experiment focusing on the hypoxia-inducing factor-1α(HIF-1α)-mediated mitochondrial autophagy. For the clinical trial, 70 patients with sepsis-associated lung injury treated in the emergency intensive care unit of the First Affiliated Hospital of Zhengzhou University were included. The levels of interleukin(IL)-6 and tumor necrosis factor(TNF)-α were measured on days 1 and 5 for every patient. Real-time quantitative polymerase chain reaction(RT-qPCR) was performed to determine the mRNA level of hypoxia inducible factor-1α(HIF-1α) in the peripheral blood mononuclear cells(PBMCs). For the animal experiment, 32 SPF-grade male C57BL/6J mice(5-6 weeks old) were randomized into 4 groups: sham group(n=6), SFI+sham group(n=10), SFI+cecal ligation and puncture(CLP) group(n=10), and CLP group(n=6). The body weight, body temperature, wet/dry weight(W/D) ratio of the lung tissue, and the pathological injury score of the lung tissue were recorded for each mouse. RT-qPCR and Western blot were conducted to determine the expression of HIF-1α, mitochondrial DNA(mt-DNA), and autophagy-related proteins in the lung tissue. The results of the clinical trial revealed that the SFI group had lowered levels of inflammatory markers in the blood and alveolar lavage fluid and elevated level of HIF-1α in the PBMCs. The mice in the SFI group showed recovered body temperature and body weight. lowered TNF-α level in the serum, and decreased W/D ratio of the lung tissue. SFI reduced the inflammatory exudation and improved the alveolar integrity in the lung tissue. Moreover, SFI down-regulated the mtDNA expression and up-regulated the protein levels of mitochondrial transcription factor A(mt-TFA), cytochrome c oxidase Ⅳ(COXⅣ), HIF-1α, and autophagy-related proteins in the lung tissue of the model mice. The findings confirmed that SFI could promote mitophagy to improve mitochondrial function by regulating the expression of HIF-1α.

Quality assessment and its influencing factors of lung cancer clinical research registration: a cross-sectional analysis.

Background: A better understanding of the current features of lung cancer clinical research registration is important for improving registration quality and standardizing the registration. This study aimed to assess the registration quality of lung cancer studies on ClinicalTrials.gov and analyze the influencing factors. Methods: Lung cancer clinical researches registered in the ClinicalTrials.gov database were searched on 7 July 2021. The characteristics of trials that registered up to 7 July 2021 were assessed. The quality of completed and terminated lung cancer studies from 1 July 2007 to 7 July 2020 was assessed using a modified version of the World Health Organization (WHO) Trial Registration Data Set (TRDS, V.1.3.1). Multivariate logistic regression analysis was also used to analyze the factors influencing study registration quality. An above-average registration quality score represented a high registration quality. Results: A total of 6,448 clinical studies on lung cancer were used to summarise the registration characteristics. Most interventional studies were randomized (41.88%), single group (48.07%), and open-label (82.86%) studies, while most observational studies were cohort studies (59.08%). In total, 2,171 completed and terminated studies were assessed, with an average quality score (out of 54) of 36.76±5.69. None of the assessed studies had a 100% modified TRDS reporting rate, and missing summary results were the main factor affecting the quality scores. Multivariate logistic regression analyses showed that prospective registrations [adjusted odds ratio (aOR), 2.18; 95% confidence interval (CI), 1.79-2.65], multi-center studies (aOR, 1.73; 95% CI, 1.39-2.16), government-sponsored studies (aOR, 3.09; 95% CI, 1.48-6.42), and published studies (aOR, 1.43; 95% CI, 1.15-1.78) were more likely to be high quality research. Conclusions: To improve the quality of registration, awareness of prospective registration should be further improved and government investment should be increased. At the same time, more efficient and extensive data sharing after completion of the studies should be actively promoted.

Modelled Economic Analysis for Dacomitinib-A Cost Effectiveness Analysis in Treating Patients With EGFR-Mutation-Positive Non-Small Cell Lung Cancer in China.

OBJECTIVES: To establish the cost-effectiveness of dacomitinib compared to gefitinib from the Chinese healthcare system perspective. PATIENTS: Advanced non-small cell lung cancer (NSCLC) harbouring epidermal growth factor receptor (EGFR) mutations. METHODS: Partitioned survival analysis was undertaken to examine the cost-effectiveness of dacomitinib utilising individual patient data (IPD) from the pivotal randomised controlled trial (RCT) (ARCHER 1050). The three health states modelled were progression-free, post-progression, and death. Parametric survival distributions were fitted to IPD against the Kaplan-Meier survival curves corresponding to progression-free survival (PFS) and overall survival (OS) outcomes by randomised groups. Costs included drug acquisition and administration, outpatient management (outpatient consultation and examinations), and best supportive care costs. Utility weights were sourced from the pivotal trial and other published literature. The incremental cost-effectiveness ratio (ICER) was calculated with costs and quality-adjusted life years (QALYs) discounted at an annual rate of 5%. Both deterministic and probabilistic sensitivity analyses were undertaken. RESULTS: In the base case, dacomitinib (CNY 265,512 and 1.95 QALY) was associated with higher costs and QALY gains compared to gefitinib (CNY 247,048 and 1.61 QALYs), resulting in an ICER of CNY 58,947/QALY. Using the empirical WTP/QALY threshold, dacomitinib is a cost-effective treatment strategy for patients with EGFR-mutation-positive advanced NSCLC. The probabilistic sensitivity analysis suggested that dacomitinib had a 97% probability of being cost-effective. CONCLUSIONS: Dacomitinib is a cost-effective treatment strategy in treating patients with EGFR-mutation-positive NSCLC from the Chinese healthcare system perspective. The uncertainty around the cost-effectiveness of dacomitinib could be reduced if long-term survival data become available. CLINICAL TRIAL REGISTRATION: NCT01024413.

Tanshinone IIA protects murine chondrogenic ATDC5 cells from lipopolysaccharide-induced inflammatory injury by down-regulating microRNA-203a.

BACKGROUND: Osteoarthritis is the most common bone-joint disease in middle and older people all over the world. Tanshinone IIA (Tan IIA) is the main lipophilic diterpenoid isolated from the root of Salvia miltiorrhiza Bunge (Lamiaceae). This study analyzed the protective effects of Tan IIA on lipopolysaccharide (LPS)-induced murine chondrogenic ATDC5 cell inflammatory injury model. METHODS: Cell viability was assessed using cell counting kit-8 (CCK-8) assay. Cell apoptosis was detected using Annexin V-FITC/PI staining. Enzyme-linked immunosorbent assay (ELISA) was conducted to measure the concentrations of interleukin 6 (IL-6), IL-8 and tumor necrosis factor α (TNF-α) in the culture supernatant of ATDC5 cells. qRT-PCR was performed to determine the expression of IL-6, IL-8, TNF-α and microRNA-203a (miR-203a) in ATDC5 cells. Cell transfection was used to enhance the expression of miR-203a. Protein expression of key factors involved in apoptosis, pro-inflammatory reaction, Janus kinase/signal transducers and activators of transcription (JAK/STAT) and c-Jun-N-terminal kinase (JNK) pathways were evaluated using western blotting. RESULTS: LPS significantly induced ATDC5 cell inflammatory injury, as evidenced by the loss of cell viability, enhancement of cell apoptosis and increases of pro-inflammatory factors expression. Tan IIA obviously alleviated LPS-induced ATDC5 cell inflammatory injury and down-regulated the expression of miR-203a. Overexpression of miR-203a obviously promoted ATDC5 cell inflammatory injury and remarkably reversed the protective effects of Tan IIA on LPS-induced ATDC5 cell inflammatory injury by influencing JAK/STAT and JNK pathways. CONCLUSION: Our research verified that Tan IIA protected ATDC5 cells from LPS-induced inflammatory injury by down-regulating miR-203a and suppressing JAK/STAT and JNK pathways.

Oxidized low-density lipoprotein promotes osteoclast differentiation from CD68 positive mononuclear cells by regulating HMGB1 release.

Patients with ankylosing spondylitis (AS) have an increased risk for cardiovascular mortality. The circulating ox-LDL/LDL ratio is associated with subclinical atherosclerosis in patients with systemic lupus erythematosus. In this study, we found that the ox-LDL/LDL ratio was increased in AS patients. The levels of serum RANKL and HMGB1 were also elevated in AS patients, and the number of CD68+/RANK+ cells was increased in peripheral blood from AS patients. 0.03% ox-LDL in LDL, similar to the ox-LDL/LDL ratio in peripheral blood from AS patients, promoted cytoplasmic translocation and release of HMGB1 as well as RANK expression. Further investigation evidenced that ox-LDL-induced EGR1 expression contributed to the cytoplasmic translocation of HMGB1 and CD68 assisted the secretion of HMGB1 from cytoplasm to extracellular matrix. Extracellular HMGB1 induced RANK expression in CD68+ mononuclear cells, forming osteoclast precursors that were differentiated to osteoclasts in response to RANKL. Taken together, these results suggested that the changes, including ox-LDL/LDL ratio, CD68+/RANK+ cells number, and the levels of RANKL and HMGB1 in AS patients, favored osteoclastogenesis.

Impact of anticancer drugs price cut on physician's prescription choices on first-line chemotherapy regimens and health expenditure for advanced non-small cell lung cancer in China.

BACKGROUND: Increases in insurance coverage and price cut of drugs are two important measures to make health care more accessible and affordable. As far as we know, this was the first study to explore the impact of anticancer drug price cut on health expenses and oncologist's prescription decisions in China. METHODS: The 511 non-small cell lung cancer (NSCLC) patients were recruited from Qilu Affiliated Hospital of Shandong University from January 1, 2003 to December 31, 2010. We categorized the patients into five groups based on China's fifth population census in 2000, including administrative group, workers and services group, peasants group, professionals group and others group. All statistical analyses were performed using SPSS (version 16.0), all statistic tests were two-tailed and P value ≤0.05 was considered significant. RESULTS: As for the first-line chemotherapy regimens prescribed during the study, 27.6% patients received vinorelbine + cisplatin (NP), 31.5% and 30.9% patients had gemcitabine + cisplatin (GC) and docetaxel + cisplatin (DC), respectively, while only 4.3% patients received paclitaxel + cisplatin or carboplatin (TP). Before price policy implementation, NP was the most popularly used regimen (44.6%). By contrast, doctors' prescription choices changed significantly after drug price cut, GC took first place (42.0%). GC became the most expensive regimen (4,431.40 RMB per cycle, about 665.15 dollars per cycle), while NP cost the least (1,974.48 RMB per cycle, about 296.37 dollars per cycle) after price cut. No significant reduction could be seen for both the pharmaceutical spending and total expense per inpatient episode after drug price adjustment. One interesting phenomena was that doctors relied less on patient's sex, age, histology to make their decisions, by contrast, more on patient's occupation and health insurance type. And, the total drug cost was closely related to patient occupation and health insurance type. CONCLUSIONS: The introduction of anticancer drug price control policy was found to be ineffective on the containment of hospital drug expenditures in one cancer center in China.

CS/PAA@TPGS/PLGA nanoparticles with intracellular pH-sensitive sequential release for delivering drug to the nucleus of MDR cells.

Development of novel nano-drug delivery systems (NDDS) that can transport anticancer drugs into cell nuclei is still a highly desirable strategy for reversing multi-drug resistance (MDR) in cancer therapy. Herein, we designed and prepared a novel NDDS, designated S@L NPs, in which several smaller nanoparticles are contained within a larger nanoparticle. Our S@L NPs (CS/PAA/VP-16@TPGS/PLGA NPs) possess a structure in which smaller nanoparticles (Chitosan-Poly(acrylic acid) nanoparticles, CS/PAA NPs) containing the drug etoposide (VP-16) are loaded within a larger nanoparticle (Vitamin E d-a-tocopheryl polyethylene glycol 1000 succinate-modified poly(lactic-co-glycolic acid) nanoparticles, TPGS/PLGA NPs). The system utilizes intracellular pH gradients to achieve pH-sensitive sequential release within different intracellular domains of MDR cells. S@L NPs could be triggered to degrade and release CS/PAA/VP-16 NPs in the acid environment of the cytosol, endosomes or lysosomes, and CS/PAA/VP-16 NPs were capable of entering the nucleus through nucleopores. It is significant that CS/PAA/VP-16 NPs exhibit disaggregation in the alkaline environment of the nucleus and thereby release the contained anticancer drug. Further mechanistic studies showed that CS/PAA/VP-16 NPs escaped retention and degradation within lysosomes and protected the drug from P-glycoprotein-induced efflux. Simultaneously, S@L NPs enhanced the anticancer effect of the loaded drug by inducing autophagy and apoptosis of MDR cells. This novel NDDS may provide a promising platform for nuclear drug delivery for reversing MDR.

Salvianolic acid A inhibits angiotensin II-induced proliferation of human umbilical vein endothelial cells by attenuating the production of ROS.

AIM: To investigate the action of salvianolic acid A (SalA) on angiotensin II (Ang II)-induced proliferation of human umbilical vein endothelial cells (HUVECs) and the possible signaling pathways mediating this action. METHODS: Cell proliferation was examined with MTT assay. The expression levels of Src phosphorylation (phospho-Src), Akt phosphorylation (phospho-Akt), and NADPH oxidase 4 (Nox4) in HUVECs were determined by Western blot. The production of reactive oxygen species (ROS) was estimated using fluorescence-activated cell sorting (FACS). RESULTS: SalA (6.25-50 µmol/L) did not affect the viability of HUVECs. Treatment of HUVECs with Ang II (1 µmol/L) markedly increased the cell viability; pretreatment of HUVECs with SalA (12.5, 25 and 50 µmol/L) prevented Ang II-induced increase of the cell viability in a concentration-dependent manner. Treatment of HUVECs with Ang II (1 µmol/L) markedly up-regulated the protein expression levels of phospho-Src, phospho-Akt (473) and Nox4; pretreatment of HUVECs with SalA (12.5, 25 and 50 µmol/L) blocked all the effects in a concentration-dependent manner. Treatment of HUVECs with Ang II (1 µmol/L) dramatically increased ROS production in HUVECs; pretreatment of HUVECs with SalA (12.5, 25 and 50 µmol/L) blocked the ROS production in a concentration-dependent manner. CONCLUSION: SalA inhibits Ang II-induced proliferation of HUVECs via reducing the expression levels of phospho-Src and phospho-Akt (473), thereby attenuating the production of ROS.