Efficacy and tolerability of pharmacological interventions for pulmonary arterial hypertension: A network meta-analysis.

PURPOSE: This network meta-analysis (NMA) is designed to compare the efficacy and tolerability of various therapies and combinations for pulmonary arterial hypertension (PAH). METHOD: We conducted a systematic search in databases PubMed, Embase, and Cochrane Library. Treatment efficacy and tolerability were compared by synthesizing direct and indirect evidence. The surface under the curve ranking area was utilized to rank multiple interventions. RESULT: A total of 43 randomized clinical trials were included in our NMA. With regard to efficacy outcomes, including 6 min walking distance (6MWD), functional class amelioration (FCA), death, clinical worsening (CW), pulmonary vascular resistance (PVR), mean pulmonary artery pressure (mPAP), cardiac index (CI), and mean right atrial pressure (mRAP), endothelin receptor antagonists (ERA), phosphodiesterase 5 inhibitor (PDE-5Is), ERA combined with PDE-5Is (EAP), and prostacyclin analogs (PGI) combined with ERA (PAE) performed better than others. Meanwhile PAP and PGE demonstrated better than others in tolerability. Overall, EAP and PAE showed good efficacy and were well-tolerated among all therapies. CONCLUSION: Overall, we recommend EAP as the optimal choice for patients with PAH in clinical practice and PAE as suboptimal in view of their desirable performance in efficacy. Most of the combination therapies performed better than monotherapies.

Novel treatment for chylothorax after esophagectomy with 50% glucose pleurodesis.

Chylothorax is characterized by the presence of chyle in the pleural space and cardiothoracic surgery accounts for nearly half of all the cases. Treatment of chylothorax has traditionally been nonoperative, with alternative medical therapies involving the administration of octreotide or pleurodesis. Pleurodesis with chemical agents has previously been reported, but never with 50% glucose and 0.1% xylocaine. Herein, we report a successful method of intrapleural instillation of 50% glucose and 0.1% xylocaine to treat chylothorax. Five patients treated with this method were all recovered rapidly. This method can generate extensive adherence and prevent the effusion of the chylous fluid with minor side effects.

Effect of active cycle of breathing techniques in patients with chronic obstructive pulmonary disease: a systematic review of intervention.

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) often suffer from expectoration. To address this problem, active cycle of breathing techniques (ACBT) can be applied. However, the effects of ACBT on COPD patients have shown mixed results. Therefore, we investigated the effectiveness of ACBT in patients with COPD by conducting a systematic review of the literature. EVIDENCE ACQUISITION: Seven electronic databases (PubMed, Web of Science, Embase, CINAHL, China National Knowledge Infrastructure [CNKI], Chinese Biomedical Literature [CBM], and Wanfang Database) were carefully searched from August 17th to 19th, 2019. EVIDENCE SYNTHESIS: The search yielded 2224 records, and ultimately only eight articles were selected for analysis. A total of 390 patients were included in the eight studies. The intervention program is a comparison of ACBT with non-ACBT. For COPD patients, ACBT was more effective in sputum production and cough efficiency. Compared with usual care, ACBT may improve lung function, blood gas analysis, and other parameters. CONCLUSIONS: Our systematic review found that ACBT can effectively improve the sputum production and cough efficiency in patients with COPD. However, there was no definite conclusion on the effectiveness of ACBT on lung function, blood gas analysis and other aspects. More research and quantitative analyses are needed to confirm the effectiveness of ACBT on other aspects of COPD patient.

Circular RNA PVT1 acts as a competing endogenous RNA for miR-497 in promoting non-small cell lung cancer progression.

Circular RNAs (circRNAs) are a class of covalently closed non-coding RNAs and play crucial regulatory roles in human cancer biology. The purpose of the present study was to explore the expression pattern and biological role of circular RNA PVT1 (circPVT1) in non-small cell lung cancer (NSCLC). We firstly found that circPVT1 was overexpressed in clinical NSCLC tissues and cell lines. NSCLC patients with high expression of circPVT1 exhibited aggressive clinicopathological characteristics and poor prognosis. In vitro assays of the NSCLC cell lines (H1299 and A549 cells) demonstrated that knockdown of circPVT1 inhibited NSCLC cell proliferation and induced NSCLC cell apoptosis. We further found that circPVT1 served as a competing endogenous RNA of miR-497 and indirectly regulated Bcl-2 expression in NSCLC cells. Finally, inhibition of miR-497 abrogated the effects of circPVT1 knockdown in NSCLC cells. Taken together, the results from our study indicated circPVT1 acts as an oncogene in NSCLC, and may serve as a promising therapeutic target for NSCLC patients.

Flavonoids from seeds of Camellia semiserrata Chi. and their estrogenic activity.

Two new flavonol glycosides and three known flavonoids were isolated from seeds of Camellia semiserrata Chi. The structures of these new flavonol glycosides were established as kaempferol 3-O-[(2'''''',3'''''',4''''''-triacetyl)-alpha-L-rhamnopyranosyl(1-->3)(2'''',4''''-diacetyl)-alpha-L-rhamnopyranosyl (1-->6)-beta-D-glucopyranoside] and kaempferol 3-O-[(3'''''',4''''''-diacetyl)-alpha-L-rhamnopyranosyl(1-->3)(2'''',4''''-diacetyl)-alpha-L-rhamnopyranosyl(1-->6)-beta-D-glucopyranoside] by spectroscopic methods. The estrogenic activity of these compounds was investigated by a recombinant yeast screening assay.

Stressors affecting nurses in China.

OBJECTIVES: To investigate the effect of stress involved in nursing on the physical and mental health of nurses and reduce their efficiency. DESIGN: A cross-sectional descriptive survey. METHOD: The present study was conducted to investigate job stress among nurses (N = 394) in three hospitals in China. Data were collected via a socio-demographic questionnaire and a nursing stress scale. RESULTS: We found that the dimension "Nursing profession and work issues" was the strongest stress factor affecting the nurses, and that the item "shift work" yielded the highest stress score. Temporary contract nurses were found to have higher stress level than permanent contract nurses (p = .038). Nurses working in the intensive care unit had the highest stress level (1.32 ± 0.948) of all the units examined. CONCLUSION: Nurses have a high risk of morbidity under the conditions of long working periods and a sustained fast-pace environment without stress management.

Free anterolateral thigh flap for coverage of scalp large defects in pediatric burn population.

Free anterolateral thigh flap is considered by most surgeons to be the proper choice for restoring scalp defect in the adult population. However, in the pediatric burn population with scalp large defects, the use of this flap has not been well described. From December 2005 to June 2009, 11 free anterolateral thigh flaps were performed to cover scalp defects in eight male children and three female children aged between 3.1 and 5.9 years (mean age: 5.0 years). Causes for the lesions include boiling liquid (5 cases), frictional heat (4 cases), and electricity (2 cases). Defect sites include parietal region (6 cases), occipital region (3 cases), temporal region (1 cases), and forehead (1 case). The size of the flaps ranged from 10 to 25 cm in length and from 8 to 18 cm in width. All the patients were followed up from 5.0 months to 2.1 years after the operation. Satisfactory contour results were shown. The overall flap success rate was 100%. There were no complications such as infections or hematomas after surgery. All the donor sites were covered with no morbidity observed. The free anterolateral thigh flap provides immediate vascularized coverage in scalp large defect that were unable to be treated by other methods, such as local flap or tissue expansion. Despite the smaller diameter of the vessels in pediatric population than that in adults, it is conceivable that this flap should be the reasonable and reliable method of large scalp defect coverage in pediatric population.