Anisodamine hydrobromide in the treatment of critically ill patients with septic shock: a multicenter randomized controlled trial.

BACKGROUND: Septic shock is the development of sepsis to refractory circulatory collapse and metabolic derangements, characterized by persistent hypotension and increased lactate levels. Anisodamine hydrobromide (Ani HBr) is a Chinese medicine used to improve blood flow in circulatory disorders. The purpose of this study was to determine the therapeutic efficacy of Ani HBr in the treatment of patients with septic shock. METHODS: This was a prospective, multicenter, randomized controlled trial focusing on patients with septic shock in 16 hospitals in China. Patients were randomly assigned in a 1:1 ratio to either the treatment group or the control group. The primary endpoint was 28-day mortality. The secondary outcomes included 7-day mortality, hospital mortality, hospital length of stay, vasopressor-free days within 7 days, etc. These indicators were measured and collected at 0, 6h, 24h, 48h, 72h and 7d after the diagnosis. RESULTS: Between September 2017 and March 2021, 404 subjects were enrolled. 203 subjects received Ani HBr and 201 subjects were assigned to the control group. The treated group showed lower 28-day mortality than the control group. Stratified analysis further showed significant differences in 28-day mortality between the two groups for patients with a high level of illness severity. We also observed significant differences in 7-day mortality, hospital mortality and some other clinical indicators between the two groups. CONCLUSION: Ani HBr might be an important adjuvant to conventional treatment to reduce 28-day mortality in patients with septic shock. A large-scale prospective randomized multicenter trial is warranted to confirm our results.

Ultrasound-guided pacemaker implantation at the bedside: A lifesaving technique for cardiac emergencies.

OBJECTIVE: To investigate the safety and effectiveness of implanting temporary pacemakers using ultrasound-guidance at the bedside for rescuing patients in case of cardiac emergencies. METHODS: We enrolled 194 patients with cardiac emergencies requiring temporary pacemakers in this study, and randomly assigned them to either a bedside ultrasound-guided installation group or an electrocardiogram-guided installation group. There were 105 cases in the bedside ultrasound-guided installation group, aged approximately 66.3 ± 10.2 years, and 89 cases in the electrocardiogram-guided installation group, aged approximately 65.8 ± 9.5 years old, and disease composition was similar between the two groups. We then compared the duration of the procedure, success rates, and occurrence of adverse events between the two groups. RESULTS: The two groups showed similar clinical characteristics. The success rates of venipuncture and temporary pacemaker electrode placement were both 100% in the bedside ultrasound-guided installation group, compared to 87.8% and 96.7% respectively, in the electrocardiogram-guided installation group, with a statistically significant difference between the two groups. The duration of puncture was significantly shorter in the bedside ultrasound-guided installation group than in the electrocardiogram-guided installation group, with statistically significant differences. Moreover, no adverse events such as hematoma, pneumothorax and electrode dislodgement occurred in the bedside ultrasound-guided installation group, while 13 cases in the electrocardiogram-guided installation group experienced adverse events, and the difference was statistically significant. CONCLUSIONS: The bedside installation of temporary pacemakers using ultrasound guidance is a simple, safe, effective, and cost-efficient procedure that boasts a high success rate, does not involve radiation, and enables accurate placement of the electrode catheter.

A Study on the Effectiveness of 650-nm Red-Light Feeding Instruments in the Control of Myopia.

INTRODUCTION: This study analyzed the effectiveness of 650-nm red-light feeding instruments in the control of myopia. METHODS: In this study, 164 school-aged participants diagnosed with myopia in the city of Shenzhen were enrolled in a red-light feeding instrument study. Of these, 41 were enrolled in the mild-to-moderate myopia group that received red-light feeding (RLMM group), 65 were enrolled in the mild-to-moderate myopia group that received single-vision spectacle treatment (SVSMM group), and 58 were included in the severe myopia group that received red-light feeding (RLS group). RESULTS: After the baseline values of the three groups were matched, the right eye data were used for statistical analysis. The average return visit time of each group was 60.42 days, and changes in the observation indexes before treatment and after follow-up treatment were compared. As the primary outcome, the axial length changes in the right eye of the SVSMM group (0.08 ± 0.40 mm), the RLMM group (-0.03 ± 0.11 mm), and the RLS group (-0.07 ± 0.11 mm) were compared and showed a statistical result of p < 0.001. CONCLUSION: The study results verified that red light had a noticeable effect on the control of myopia and that low-level red-light therapy played a vital role in the treatment of severe myopia.

The Influence of Parents' Background and Their Perception on the Progression of Myopia in Children.

Purpose: To study the influence of parents' educational backgrounds and understanding on the progress of myopia in their offspring. Methods: Spherical equivalent refraction (SE) of the children (aged 6-14) in China was assessed with cycloplegic autorefraction in a two-year longitudinal study. The parents' background information and myopia-related cognition were collected by questionnaires. Results: The offspring of parents with lower education and more myopic SE had higher myopic progression (mean = -1.42 ± 1.06) than the children of other groups (P < 0.05). The parents' understanding of the proper outdoor activity time, sleep duration, reading distance, and indoor illumination for children was not significantly correlated with the progression of myopia in their offspring. The parent's preference for eye care visit frequency had a significant correlation with the myopia development of their children (r = 0.076, P=0.001∗). The mean SE progression was -0.84 ± 1.37 and -0.58 ± 1.29 in the children whose parents considered that extracurricular classes would negatively affect myopia development progression and the children whose parents believed it would not, respectively (P=0.026∗). Conclusions: Most parents misunderstand the influence of insufficient outdoor sports time and extracurricular classes, which require extra near-vision work. Besides, for parents with low educational background and more myopic SE, their offspring had higher myopia progression and may be the key group for myopia control. Finally, parents may obtain life advice and knowledge related to preventing myopia after their children become myopic. It may be of positive significance if this process could take place before myopia onset.

Secondary donor-derived humanized CD19-modified CAR-T cells induce remission in relapsed/refractory mixed phenotype acute leukemia after allogeneic hematopoietic stem cell transplantation: a case report.

BACKGROUND: Mixed phenotype acute leukemia (MPAL) is a rare leukemia and is regarded as a high-risk entity with a poor prognosis. Induction therapy of an acute lymphoblastic leukemia type or hybrid regimen and hematopoietic stem cell transplantation has been recommended for MPAL. However, the optimal therapies for relapsed or refractory MPAL remain unclear, especially for relapse after stem cell transplantation. Donor-derived chimeric antigen receptor T (CAR-T) cell therapy may be a promising therapeutic option for patients with MPAL who express target antigens and have relapsed after stem cell transplantation. However, recurrence remains a challenge, and reinfusion of CAR-T cells is not always effective. An infusion of secondary donor-derived humanized CD19-modified CAR-T cells may be effective in inducing remission. CASE PRESENTATION: We report a case of MPAL with CD19 expression. The patient was treated with acute lymphoblastic leukemia-like induction and consolidation therapies but remained positive for SET-NUP214 fusion gene transcript. He subsequently underwent a haploidentical stem cell transplantation but relapsed within 6 months. He then underwent donor-derived CD19-targeted CAR-T cell therapy and achieved a sustained, complete molecular remission. Unfortunately, he developed a CD19-positive relapse after 2 years. Donor-derived humanized CD19-directed CAR-T cells induced a second complete molecular remission without severe cytokine release syndrome or acute graft-versus-host disease. CONCLUSION: This case demonstrated the efficacy and safety of humanized donor-derived CD19-modified CAR-T cell infusion for treating the recurrence of MPAL previously exposed to murine-derived CD19-directed CAR-T cells.

Imidazo[1,2-a]pyridine as an Electron Acceptor to Construct High-Performance Deep-Blue Organic Light-Emitting Diodes with Negligible Efficiency Roll-Off.

Two novel bipolar deep-blue fluorescent emitters, IP-PPI and IP-DPPI, featuring different lengths of the phenyl bridge, were designed and synthesized, in which imidazo[1,2-a]pyridine (IP) and phenanthroimidazole (PI) were proposed as an electron acceptor and an electron donor, respectively. Both of them exhibit outstanding thermal stability and high emission quantum yields. All the devices based on these two materials showed negligible efficiency roll-off with increasing current density. Impressively, non-doped organic light-emitting diodes (OLEDs) based on IP-PPI and IP-DPPI exhibited external quantum efficiencies (EQEs) of 4.85 % and 4.74 % with CIE coordinates of (0.153, 0.097) and (0.154, 0.114) at 10000 cd m-2 , respectively. In addition, the 40 wt % IP-PPI doped device maintained a high EQE of 5.23 % with CIE coordinates of (0.154, 0.077) at 10000 cd m-2 . The doped device based on 20 wt % IP-DPPI exhibited a higher deep-blue electroluminescence (EL) performance with a maximum EQE of up to 6.13 % at CIE of (0.153, 0.078) and maintained an EQE of 5.07 % at 10000 cd m-2 . To the best of our knowledge, these performances are among the state-of-the art devices with CIEy ≤0.08 at a high brightness of 10000 cd m-2 . Furthermore, by doping a red phosphorescent dye Ir(MDQ)2 (MDQ=2-methyldibenzo[f,h]quinoxaline) into the IP-PPI and IP-DPPI hosts, high-performance red phosphorescent OLEDs with EQEs of 20.8 % and 19.1 % were achieved, respectively. This work may provide a new approach for designing highly efficient deep-blue emitters with negligible roll-off for OLED applications.

Comparative analysis of a panel of biomarkers related to protein phosphatase 2A between laryngeal squamous cell carcinoma tissues and adjacent normal tissues.

Laryngeal squamous cell carcinoma (LSCC) is the most common type of head and neck squamous cell carcinoma (HNSCC) worldwide. Protein phosphatase 2A (PP2A) dysfunction has been widely reported in a broad range of malignancies due to its distinctive role in miscellaneous cellular processes. However, it is poorly understood whether aberrant alterations of PP2A are involved in the network of oncogenic events in LSCC. Here, we detected a panel of PP2A-associated proteins using western blot in both laryngeal squamous cell carcinoma tissues and paired adjacent normal tissues from patients (Data S1). We found that phospho-PP2A/C (Y307), α4, cancerous inhibitor of protein phosphatase 2A (CIP2A), Akt, ezrin, phospho-ezrin (T567), 14-3-3, and focal adhesion kinase (FAK) showed increased expression levels in carcinoma tissues relative to normal tissues, while phospho-Akt (T308) showed decreased levels. Our study, thus, provides a rationale for targeting PP2A to develop novel therapies and proposes a combination of interrelated biomarkers for the diagnostic evaluation and prognosis prediction in LSCC.

Does high-flow nasal cannula oxygen improve outcome in acute hypoxemic respiratory failure? A systematic review and meta-analysis.

INTRODUCTION: To evaluate the efficacy of high-flow nasal cannula (HFNC) in the rate of intubation and mortality for patients with acute hypoxemic respiratory failure. METHODS: We searched Pubmed, EMBASE, and the Cochrane Library for relevant studies. Two reviewers extracted data and reviewed the quality of the studies independently. The primary outcome was the rate of intubation; secondary outcome was mortality in the hospital. Study-level data were pooled using a random-effects model when I2 was >50% or a fixed-effects model when I2 was <50%. RESULTS: Eight randomized controlled studies with a total of 1,818patients were considered. Pooled analysis showed that no statistically significant difference was found between groups regarding the rate of intubation (odds ratio [OR] = 0.79; 95% confidence interval [CI]: 0.60-1.04; P = 0.09; I2 = 36%) and no statistically significant difference was found between groups regarding hospital mortality (OR = 0.89; 95% CI: 0.62-127; P = 0.51; I2 = 47%). CONCLUSIONS: The use of HFNC showed a trend toward reduction in the intubation rate, which did not meet statistical significance, in patients with acute respiratory failure compared with conventional oxygen therapy (COT) and noninvasive ventilation (NIV). Moreover no difference in mortality. So, Large, well-designed, randomized, multi-center trials are needed to confirm the effects of HFNC in acute hypoxemic respiratory failure patients.

Diagnostic value of brain natriuretic peptide and ß-endorphin plasma concentration changes in patients with acute left heart failure and atrial fibrillation.

RATIONALE: This study aims to evaluate the diagnostic value of beta-endorphin (ß-EP) and brain natriuretic peptid (BNP) plasma concentrations for the early diagnosis of acute left heart failure and atrial fibrillation. PATIENT CONCERNS: A total of 45 patients were included. These patients comprised 23 male and 22 female patients,and 20 healthy subjects who underwent physical examinations in the Outpatient Department during the same periodwere included and assigned to the control group. DIAGNOSES: The diagnos stand was that of the Chinese guidelines for the diagnosis and treatment of heart failure. INTERVENTIONS: Enzyme-linked immunosorbent assay was performed to detect the plasma concentration of ß-EP and BNP in the treatment and control groups, and electrocardiogram targeting was performed to determine the left ventricular ejection fraction (LVEF). OUTCOMES: BNP, ß-EP, and LVEF levels were higher in the treatment group (688.01 ±â€Š305.78 ng/L, 394.06 ±â€Š180.97 ng/L, and 70.48 ±â€Š16.62%) compared with the control group (33.90 ±â€Š8.50 ng/L, 76.87 ±â€Š57.21 ng/L, and 32.11 ±â€Š5.25%). The P-values were .015, .019, and .026, respectively, which were <.05. The difference was statistically significant. The BNP and ß-EP's 4 correlations (r = 0.895, P <.001), BNP, ß-EP, and the combination of BNP and ß-EP for acute left heart failure diagnosis in maximizing Youden index sensitivity, specific degree, area under the ROC curve (AUC), and 95% confidence interval (CI) were respectively 93.5%, 81.3%, 0.921, 0.841, 0.921; 80.5%, 78.6%, 0.697, 0.505, 0.697; 94.1%, 83.5%, 0.604 to 0.979, and 0.604. Acute left heart failure in patients with LVEF acuity plasma BNP and ß-EP 50% group was obviously lower than that in the LVEF <50% group (P <.01). BNP, ß-EP, and LVEF were negatively correlated (r = -0.741, -0.635, P = .013, .018). LESSONS: ß-EP and BNP have high specificity and sensitivity for detecting early acute left heart failure and atrial fibrillation in patients, which is convenient, easy to perform, and suitable for clinical applications.

Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials.

PURPOSE: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are 2 of the most widely used bariatric procedures today, in this meta-analysis, both techniques were compared for evaluating the efficacy and safety of the treatment of morbid obesity. MATERIALS AND METHODS: Systematic literature search of Cochrane Controlled Trials Register Databases, Medline, Embase, ISI databases, and Chinese Biomedical Literature Database was performed. Statistical analyses were carried out using RevMan software. RESULTS: Thirty-two recent studies including 6526 patients in total were included in this meta-analysis. Compared with SG, RYGB had significantly better effect in resolving type 2 diabetes mellitus, hypertension, hypercholesterolemia, gastroesophageal reflux disease, and arthritis. However, RYGB had higher incidence of complications and reoperation, and longer operation time than SG. CONCLUSIONS: RYGB was more effective than SG in the resolution of obesity-related comorbidities, SG was a safer procedure with a reduced rate of complications and reoperation.

Fluvastatin upregulates the α 1C subunit of CaV1.2 channel expression in vascular smooth muscle cells via RhoA and ERK/p38 MAPK pathways.

Abnormal phenotypic switch of vascular smooth muscle cell (VSMC) is a hallmark of vascular disorders such as atherosclerosis and restenosis. And this process has been related to remodeling of L-type calcium channel (LTCC). We attempted to investigate whether fluvastatin has any effect on VSMC proliferation and LTCCα 1C subunit (LTCCα 1C) expression as well as the potential mechanisms involved. The VSMCs proliferation was assayed by osteopontin immunofluorescent staining and [(3)H]-thymidine incorporation. The cell cycle was detected by flow cytometric analysis. The activity of RhoA was determined with pull-down assay. MAPK activity and LTCCα 1C expression were assessed by western blotting. We demonstrated fluvastatin prevented the VSMCs dedifferentiating into a proliferative phenotype and induced cell cycle arrest in the G0/G1 phase in response to PDGF-BB stimulation. Fluvastatin dose-dependently reversed the downregulation of LTCCα 1C expression induced by PDGF-BB. Inhibition of ROCK, ERK, or p38 MAPK activation largely enhanced the upregulation effect of fluvastatin (P < 0.01). However, blockade of JNK pathway had no effect on LTCCα 1C expression. We concluded LTCCα 1C was a VSMC contractile phenotype marker gene. Fluvastatin upregulated LTCCα 1C expression, at least in part, by inhibiting ROCK, ERK1/2, and p38 MAPK activation. Fluvastatin may be a potential candidate for preventing or treating vascular diseases.

Synovial sarcoma of the neck masquerading as a malignant second branchial cleft cyst.

Synovial sarcoma is an uncommon, aggressive malignant tumor of the soft tissues primarily involving the extremities of young adults. Head and neck synovial sarcoma is rare, and its diagnosis and therapy are still challenging.We report a case of a young patient with synovial sarcoma, clinically masquerading as cystic mass of the neck and malignant second branchial cleft cyst. The pathological diagnosis of the sarcoma was confirmed by a multimodality diagnostic protocol, including histological, immunohistochemical and molecular genetic analysis. The patient underwent complete surgical excision followed by postoperative radiotherapy and recovered well.

[Comparison of the effect between early anatomical open reduction, internal fixation and closed reduction, internal fixation for treatment of children displaced femoral neck fracture].

OBJECTIVE: To compared the effect between early anatomical open reduction, internal fixation (ORIF) and closed reduction, internal fixation (CRIF) for treatment of children displaced femoral neck fracture. METHODS: From March 2006 to May 2010,34 children with displaced femoral neck fractures were reviewed retrospectively. These patients were divided into two groups. Among them, 19 cases were treated by open reduction and internal fixation (ORIF) as group A, included 11 males and 8 females with an average age of (8.1 +/- 1.3), the other 15 cases were treated by closed reduction and internal fixation (CRIF) as group B, included 9 males and 6 females with an average age of (7.9 +/- 1.5). Complications were observed and the short term effectiveness was evaluated by Ratliff standard. RESULTS: All children were followed-up from 1 to 3 years (means 1.2 years). All fractures were healed. There was statistical different in the curative effects between the two groups (Z=2.389, P= 0.017). The incidence of complications in two groups had statistical different (P=0.046). CONCLUSION: The early ORIF could get better reduction with fewer complications than CRIF in fractures of the displaced femoral neck in children in Delbet type-II and type-III, therefore, ORIF should be considered.

[Clinical analysis of 10 cases of olfactory neuroblastoma].

OBJECTIVE: To review the diagnosis, treatment and prognosis of olfactory neuroblastoma. METHODS: Clinical data were retrospectively reviewed in 10 cases of olfactory neuroblastoma admitted from 1998 to 2002, including data of transmission electron microscopic (TEM) observation in 4 cases. According to Kadish's classification, 2 cases were in stage A, 4 in stage B and 4 in stage C. Three patients were treated with surgery alone, 7 with combined surgery and radiation. RESULT: Among 10 cases, the overall 5-year survival rate was 60 %(6/10); 3 patients died from local recurrence, 1 lost follow-up. TEM demonstrated granules in the cytoplasm of 3 patients. CONCLUSION: The combined surgery and radiation can achieve excellent local control. Transmission electron microscope is important for its diagnosis.

Estrogen receptor-beta mediates cyclooxygenase-2 expression and vascular prostanoid levels in human placental villous endothelial cells.

OBJECTIVE: Regulation of fetoplacental blood flow is likely mediated by factors such as prostanoids. Estrogen and its receptors affect prostanoid biosynthesis. Previously, we demonstrated that villous endothelial cells express estrogen receptor-beta (ESR2), and we sought to determine its role in the mediation of fetoplacental vascular function. STUDY DESIGN: Villous endothelial cells from uncomplicated pregnancies were isolated, cultured, and treated with estrogen. RNA interference, real-time polymerase chain reaction, Western blotting, and enzyme immunoassays were performed. RESULTS: Cyclooxygenase-2 (COX-2) expression levels were not altered consistently by estrogen. RNA interference of ESR2 led to a concomitant decrease in COX-2 messenger RNA (P < .0001) and protein (P < .05) in the presence and absence of estradiol. ESR2 knock-down also led to diminished prostacyclin and thromboxane concentrations in the absence of estradiol (P < .005). CONCLUSION: ESR2 mediates COX-2 expression levels and both prostacyclin and thromboxane concentrations in the basal state, which suggests the possibility of ligand-independent regulation of COX-2 activity and prostaglandin H2 substrate availability. Further investigation regarding ESR2 regulation of prostanoid biosynthesis and its effects on the fetoplacental vasculature is warranted.

Regulation of 17-beta hydroxysteroid dehydrogenase type 2 in human placental endothelial cells.

17-beta hydroxysteroid dehydrogenase type 2 (HSD17B2) oxidizes estradiol to estrone, testosterone to androstenedione, and 20 alpha-dihydroprogesterone to progesterone. HSD17B2 is highly expressed in human placental tissue where it is localized to placental endothelial cells lining the fetal compartment. The aim of this study was to investigate the effects of potential regulatory factors including progesterone, estradiol, and retinoic acid (RA) onHSD17B2 expression in primary human placental endothelial cells in culture.HSD17B2 mRNA expression was not regulated by progesterone, the progesterone agonist R5020, or estradiol treatment. RA significantly induced HSD17B2 mRNA levels and enzyme activity in a dose- and time-dependent manner. Maximal stimulation occurred at Hour 48 at an RA concentration of 10(-6) M. Both retinoic acid receptor alpha (RARA) and retinoid X receptor alpha (RXRA) were readily detected by immunoblotting in isolated placental endothelial cells. RNA interference directed against RARA or RXRA led to reduced basal levels of HSD17B2 mRNA levels and significantly abolished RA-stimulated HSD17B2 expression. Together, these data indicate that regulation of HSD17B2 mRNA levels and enzymatic activity by RA in the placenta is mediated by RARA and RXRA.