[Analysis of clinical characteristics and risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia].

Objective: To analyze and explore the clinical characteristics and risk factors related to nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia. Methods: 252 hospitalized patients with liver cirrhosis combined with atrial arrhythmia from January 2014 to December 2021 were enrolled, and their clinical characteristics were analyzed. The above-mentioned patients were divided into groups according to their nosocomial mortality rate. Among them, 45 nosocomial mortality cases were classified as the mortality group, and 207 survival cases were classified as the survival group. The differences in clinical data and laboratory data between the two groups were compared. The risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia were analyzed. The t-test, or rank-sum test, was used to compare measurement data. The chi-square test, or Fisher's exact probability method, was used to compare enumeration data. Multivariate analysis was performed by the logistic regression method. Results: Among the 252 cases, the male-to-female ratio was the same (male/female ratio: 126/126). The age range was 26 to 89 (66.77±10.46) years. Han ethnicity accounted for 79.5%. The main type of atrial arrhythmia was atrial fibrillation (P < 0.001). The main cause of liver cirrhosis was post-hepatitis B cirrhosis (56.3%). There were 57/72/123 cases of CTP grade A/B/C. The CTP and Model for End-Stage Liver Disease (MELD) scores were 10.30±1.77 and 18.0(11.0, 29.0), respectively. The nosocomial mortality rate was 17.9% (45/252). The overall incidence rate of complications in all patients was 89.28%, with complications occurring in the following order: 71.4% ascites, 71.0% hypersplenism, 64.7% spontaneous peritonitis, 64.3% esophageal gastric varices, 32.5% hepatorenal syndrome, 32.1% hepatic encephalopathy, and 26.2% esophageal gastric variceal bleeding. The incidence rate of new-onset atrial fibrillation in the nosocomial mortality group was 73.3%, which was much higher than the 44.0% rate in the survival group (P < 0.05). Multivariate logistic regression analysis showed that new-onset atrial fibrillation (OR=2.707, 95%CI 1.119 ~ 6.549), esophageal-gastric varices (OR=3.287, 95%CI 1.189 ~ 9.085), serum potassium (OR=3.820, 95%CI 1.532 ~ 9.526), and MELD score (OR=1.108, 95%CI 1.061~1.157) were independent risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia. Conclusion: Patients with cirrhosis combined with atrial arrhythmias have more severe liver function damage and are more likely to develop complications such as ascites, hypersplenism, and hepatorenal syndrome. New-onset atrial fibrillation, esophageal-gastric varices, hyperkalemia, and a high MELD score are risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia, so more attention should be paid to corresponding patients for timely symptomatic treatment.

[Natural history of chronic hepatitis B virus infection under low-level viremia].

Low-level viremia (LLV) is a hot and difficult topic that has gradually attracted attention in the field of chronic hepatitis B for evaluating antiviral therapy response in recent years. The presence of LLV may increase drug-resistant mutations, the progression of liver fibrosis, and potentially the development of liver cancer following antiviral therapy. Natural history of chronic HBV infection patients also have LLV, but it is unclear whether these patients are also at risk of disease progression, what the risk is, and whether early antiviral therapy is necessary and beneficial. Therefore, this article provides a reference for the all-encompassing management of this group of patients by reviewing the prevalence and impact of LLV in chronically HBV-infected patients' natural histories.

Secalonic acid- F inhibited cell growth more effectively than 5-fluorouracil on hepatocellular carcinoma in vitro and in vivo.

Hepatocellular carcinoma (HCC), one of the most common types of liver cancer, could be treated with 5-fluorouracil (5-FU). Due to its side effects, 5-FU is more often used as the co-administration drug in clinical practice. Secalonic acid-F (SAF), isolated from a fungal strain identified in our lab as Aspergillus aculeatus, showed potent biological activities. The goal of this study was to evaluate the inhibitory effects of SAF on hepatocellular carcinoma and to compare it with that of 5-FU. Results showed that SAF effectively inhibited cell growth with a dose-dependent manner in vitro and in vivo. And the inhibitory effects of SAF were stronger than that of 5-FU. Importantly, the cytotoxicity of SAF to peripheral blood mononuclear cells (PBMC) was similar to that of 5-FU. Furthermore, this study demonstrated that SAF arrested the cell cycle at the G1 phase and induced apoptosis with a dose-dependent manner by activating caspase3 and caspase9 through a mitochondrial pathway. Consequently, SAF may be a better potential candidate compound for human cancer treatment; these results will afford more data for antitumor agent design in detail.

[Analysis of the clinical features and the risk factors of severe adenovirus pneumonia in children].

Objective: To analyze the clinical characteristics, risk factors for critical illness and death of severe adenovirus pneumonia in children, so as to provide clinical evidences for early diagnosis and reliable treatment. Methods: A total of 75 pediatric cases with severe adenovirus pneumonia admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January to October 2019 were studied. The clinical features, laboratory and imaging data, therapeutic approaches, efficacy of the treatments and prognosis were investigated retrospectively. Patients were divided into severe group and critical group. Chi square test and Mann-Whitney U rank sum test were used to analyze the data of the two groups. The risk factors for critical illness and death were analyzed by univariate and multivariate Logistic regression. Results: Among the 75 children, there were 52 males and 23 females, aged from 3 months to 8 years, including 30 of severe cases and 45 of critical case. The positive rate of adenovirus antigen in nasopharyngeal swab was 21% (15/72), and the positive rate of serum adenovirus IgM antibody was only 13% (10/75). However, the positive rate of adenovirus nucleic acid in nasopharyngeal swab was 75% (21/28). What is more, the positive rates of metagenomics next generation sequencing (mNGS) in plasma and bronchoalveolar lavage fluid were 92% (33/36) and 96% (54/56), respectively, of which 95% (63/66) were confirmed as adenovirus type 7. Relatively high dose of ribavirin and integrated therapeutic approaches (respiratory support, glucocorticoids, immunoglobulin and organ supportive therapies) were used. The recovery rate was 77% (58/75), the improvement rate was 8% (6/75) and the mortality rate was 15% (11/75). The proportion of children with the duration of fever longer than 3 days after ribavirin treatment in the critical group was significantly higher than that in the severe group(51% (18/35) vs. 8% (2/26), χ2=12.949, P<0.05). The risk factors for critical illness were younger than 4 years, longer duration of fever before and after admission to PICU, oxygenation index<300 mmHg (1 mm Hg=0.133 kPa), ferritin>1 000 µg/L, lactate dehydrogenase (LDH)>1 500 U/L, 5 lung lobes involvement, pleural effusion and (or) air leakage (all P<0.05). Among them, 5 lung lobes involvement was the independent risk factor for critical illness (adjusted OR=49.641, 95%CI 4.186-588.618, P=0.002). Risk factors for death included longer duration of fever after being admitted to PICU, oxygenation index<100 mmHg, ferritin>2 000 µg/L, interleukin (IL)-6>100 ng/L, LDH>1 500 U/L, pleural effusion and (or) air leakage (all P<0.05). Among them, IL-6>100 ng/L was the independent risk factor for the mortalities of critically ill children (adjusted OR=16.094, 95%CI 2.059-25.787, P=0.008). Conclusions: The mortality rate of severe pediatric adenovirus pneumonia caused by adenovirus type 7 is high. High positive rates of adenovirus nucleic acid in nasopharyngeal swabs and mNGS in plasma or bronchoalveolar lavage fluid contribute to early diagnosis, and mNGS can also be used for serotyping. Younger children under 4 years of age, persistent fever, extensive pulmonary lesions and significantly increased inflammatory cytokines such as IL-6 are warning indicators for critical illness and poor prognosis. Relatively high dose of ribavirin combined with integrated therapeutic approaches are beneficial for prognosis.

Photosensitizer-induced self-assembly of antigens as nanovaccines for cancer immunotherapy.

Herein, the photosensitizer indocyanine green (ICG) is used to induce the self-assembly of antigens to form nanovaccines. Under near-infrared (NIR) laser irradiation, reactive oxygen species can be generated by nanovaccines to disrupt the membranes of endo/lysosomes, which helps to release antigens into the cytosol efficiently, thereby enhancing antigen cross-presentation and anti-cancer immunity. To the best of our knowledge, this study represents the first example of ICG as a biocompatible adjuvant to improve cancer vaccine efficacy.

Structure, interaction and electron transfer between cytochrome b5, its E44A and/or E56A mutants and cytochrome c.

Site-directed mutagenesis has been used to produce variants of a tryptic fragment of bovine liver cytochrome b5 in which Glu44 and Glu56 are mutated to alanine. The reduction potentials measured by spectroelectrochemical titration (in the presence of 1 mM (Ru(NH3)6)3+, pH 7.0 and I=0.1 M) are 4.5, 6.0, 6.0 and 7.5 mV versus the standard hydrogen electrode (SHE) for the wild-type and E44A, E56A and E44/56A mutants of cytochrome b5, respectively. A comparative two-dimensional NMR study of cytochrome b5 and its E44/56A mutant in water solution has been achieved. Resonance assignments of side-chains have been completed successfully. The NMR results suggest that the secondary structures and global folding of the E44/56A mutant remain unchanged, but the mutation of both Glu44 and Glu56 to hydrophobic alanine may lead to the two helices containing mutated residues contracting towards the heme center. The inner mobility of the Gly42 approximately Glu44 segment in cytochrome b5 may be responsible for the difference of the binding mode between Glu44 and Glu56 with cytochrome c. The binding between cytochrome c and cytochrome b5 was studied by optical difference spectra of cytochrome c and variants of cytochrome b5. The association constants (KA) for the wild-type, E44A, E56A, and E44/56A mutants of cytochrome b5 with cytochrome c, are 4.70(+/-0. 10)x10(6) M-1, 1.88(+/-0.03)x10(6) M-1, 2.70(+/-0.13)x10(6) M-1, and 1.14(+/-0.05)x10(6) M-1, respectively. This is indicative that both Glu44 and Glu56 are involved in the complex formation between cytochrome b5 and cytochrome c. The reduction of horse heart ferricytochrome c by recombinant ferrocytochrome b5 and its mutants has been studied. The rate constant of the electron transfer reaction between ferricytochrome c and wild-type ferrocytochrome b5 (1.074(+/-0.49)x10(7) M-1 s-1) is higher than those of the mutant protein E44A (8.98(+/-0.20)x10(6) M-1 s-1), E56A (8.76(+/-0. 39)x10(6) M-1 s-1), and E44/56A (8.02(+/-0.38)x10(6) M-1 s-1) at 15 degreesC, pH 7.0, I=0.35 M. The rate constants are strongly dependent on ionic strength and temperature. These studies, by means of a series of techniques, provide conclusive results that the interaction between cytochrome b5 and cytochrome c is electrostatically guided, and, more importantly, that both Glu44 and Glu56 participate in the electron transfer reaction.

[Isolation and identification of yibeinoside B].

A new C-nor-D-homosteroidal alkaloid named Yibeinoside B was isolated from the bulb of Fritillaria pallidiflora Schrenk by column chromatographic techniques. The structure has been determined based on spectral and chemical data.

Preliminary report on the effect of Nd: YAG laser irradiation on canine tooth pulps.

OBJECTIVE: To study the effects of Nd: YAG laser irradiation on the canine tooth pulps. METHODS: The crown pulp of dog was exposed and excised by ND: YAG laser irradiation. Histopathological examination was used to check changes of the tissues in root canal and periodontium. RESULTS: The pulp of the crown could be successfully excised by Nd: YAG laser without harmful changes in either root canal or periodontal tissues. CONCLUSION: This study may provide an experimental basis for the clinical possibility of crown pulp excision by using Nd: YAG laser irradiation.