Escalated grades of complications correlate with incremental costs of video-assisted thoracoscopic surgery major lung resection for lung cancer in China.

OBJECTIVE: Few studies have focused on factors associated with the incremental cost of video-assisted thoracoscopic surgery (VATS) in China. We aim to systematically classify the complications after VATS major lung resection and explore their correlation with hospital costs. METHODS: Patients with pathologically stage I-III lung cancer who underwent VATS major lung resections from January 2007 to December 2018 were included. The Thoracic Mortality and Morbidity (TM&M) Classification system was used to evaluate postoperative complications. Grade I and II complications, defined as minor complications, require no therapy or pharmacologic intervention only. Grade III and IV complications, defined as major complications, require surgical intervention or life support. Grade V results in death. A generalized linear model was used to explore the correlation of incremental hospital costs and complications, as well as other clinicopathologic parameters between 2013 and 2016. RESULTS: A total of 2881 patients were enrolled in the first part, and the minor and major complications rates were 24.3% (703 patients) and 8.3% (228 patients), respectively. Six hundred and eighty-two patients were enrolled in the second part. The complications grade II (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.05-1.2, p = 0.0005), grade III (OR 1.55, 95% CI 1.26-1.9, p < 0.0001), grades IV and V (OR 1.09, 95% CI 1.04-1.13, p = 0.0002), diffusion capacity of carbon dioxide (OR 0.998, 95% CI 0.997-1.000, p = 0.004), and duration of chest drainage (OR 1.03, 95% CI 1.02-1.04, p < 0.001) and were independent risk factors for the increase in in-hospital costs of VATS major lung resections. CONCLUSIONS: The severity of complications graded by the TM&M system was an independent risk factor for increased in-hospital costs.

In Vitro Assessment of Combinations of Enterovirus Inhibitors against Enterovirus 71.

Enterovirus 71 (EV-A71) is a major causative pathogen of hand, foot, and mouth disease (HFMD) epidemics. No antiviral therapies are currently available for treating EV-A71 infections. Here, we selected five reported enterovirus inhibitors (suramin, itraconazole [ITZ], GW5074, rupintrivir, and favipiravir) with different mechanisms of action to test their abilities to inhibit EV-A71 replication alone and in combination. All selected compounds have anti-EV-A71 activities in cell culture. The combination of rupintrivir and ITZ or favipiravir was synergistic, while the combination of rupintrivir and suramin was additive. The combination of suramin and favipiravir exerted a strong synergistic antiviral effect. The observed synergy was not due to cytotoxicity, as there was no significant increase in cytotoxicity when compounds were used in combinations at the tested doses. To investigate the potential inhibitory mechanism of favipiravir against enterovirus, two favipiravir-resistant EV-A71 variants were independently selected, and both of them carried an S121N mutation in the finger subdomain of the 3D polymerase. Reverse engineering of this 3D S121N mutation into an infectious clone of EV-A71 confirmed the resistant phenotype. Moreover, viruses resistant to ITZ or favipiravir remained susceptible to other inhibitors. Most notably, combined with ITZ, rupintrivir prevented the development of ITZ-resistant variants. Taken together, these results provide a rational basis for the design of combination regimens for use in the treatment of EV-A71 infections.

Metabolic profiling assisted quality assessment of Rhodiola rosea extracts by high-performance liquid chromatography.

In this work, fast and sensitive high-performance liquid chromatography (HPLC) coupled with multivariate analysis was utilized to assist the quality assessment of Rhodiola rosea extracts (RREs). 131 peaks were separated and detected in RREs on a fused-core C18 column. Principal component analysis (PCA) and hierarchical cluster analysis (HCA) of the chromatographic data demonstrated that 10 batches of RREs could be well-differentiated and categorized into three groups which were closely related to the origins of RREs. Partial least square-discriminant analysis (PLS-DA) showed that the quality differentiation might be explained by at least 6 components, in which rosavin was characterized by an external reference, rosiridine was identified by liquid chromatography-mass spectrometry (LC-MS), and the mass spectra of the others were provided. The observation that the level of rosavin was more relevant to the multivariate chromatographic data than the ones of salidroside and tyrosol, the other two components commonly used to standardize RREs, was confirmed by the PLS prediction models. Results of the present study not only indicated that rosavin was a rational marker to represent the quality of RREs, but also demonstrated the power of HPLC-based metabolic profiling in the quality assessment of herbal extracts.

Simple quality assessment approach for herbal extracts using high performance liquid chromatography-UV based metabolomics platform.

A lack of adequate or accepted research methodology has been a major obstacle to study herbal medicines. In this study, instead of the prevalent hyphenated chromatographies, common high performance liquid chromatography equipped with ultraviolet detector (HPLC-UV) and multivariate statistical analysis were utilized to assess the qualities of total flavones of sea buckthorn (TFS), an 85% ethanol extract of the sea buckthorn berries. Two complementary HPLC-UV methods were developed, validated and combined to comprehensively determine the ingredients in TFS. Principal component analysis (PCA) and partial least square-discriminant analysis (PLS-DA) of the combined analytical data showed that the six batches of TFS could be well differentiated. Hierarchical cluster analysis (HCA) using Ward's minimum variance method of the PLS-DA loading matrix demonstrated the known ingredients (quercetin, kaempferol, isorhamnetin, oleanolic acid and ursolic acid) and three unknown ingredients in TFS significantly contributed to the quality differences. A PLS regression model indicated that the results of the present method correlated well with the content of total flavones, which is now the quality control approach of TFS. Results from this study indicated that the proposed method is reliable for the quality reassessment of some widely used herbal extracts.