Visible light-induced radical cascade acylmethylation/cyclization of 2-(allyloxy)arylaldehydes with α-bromo ketones: access to cyclic 1,5-dicarbonyl-containing chroman-4-one skeletons.

A novel photocatalytic protocol for effective and efficient synthesis of cyclic 1,5-diketones containing chroman-4-one skeletons in moderate to good yields via radical cascade acylmethylation/cyclization of 2-(allyloxy)arylaldehydes with α-bromo ketones has been described. This reaction features a broad substrate scope, good functional group tolerance, and metal- and oxidant-free conditions. An acylmethyl radical-triggered cascade cyclization was involved.

Palladium/Norbornene Cooperative-Catalyzed Cascade Decarboxylative Cyclization of 4-Iodoisoquinolin-1(2H)-ones with o-Bromobenzoic Acids: Access to Diverse Fused Phenanthridinones and Hepta[1,2-c]isoquinolinones.

A novel three-component Pd/norbornene cooperative catalysis cascade decarboxylative [2+2+2]/[2+2+3]cyclization of 4-iodoisoquinolin-1(2H)-ones and o-bromobenzoic acids or 8-bromo-1-naphthoic acid has been developed. The method affords a range of fused phenanthridinones and hepta[1,2-c]isoquinolinones and displays unique regioselectivity and broad substrate scope. Palladium/norbornene (Pd/NBE)-catalyzed C-H activation and subsequent decarboxylative coupling reactions were involved, and NBE acts as a building block for the construction of rigid nonplanar molecular architectures.

Risk factors for death in tuberculosis patients requiring ICU care.

The prognostic factor for in-hospital mortality in tuberculosis (TB) patients requiring intensive care unit (ICU) care remains unclear. Therefore, a retrospective study was conducted aiming to estimate the in-hospital mortality rate and the risk factors for mortality in a high-burden setting. All patients with culture-confirmed TB that were admitted to the ICU of the hospital between March 2012 and April 2019 were identified retrospectively. Data, such as demographic characteristics, comorbidities, laboratory measures and mortality, were obtained from medical records. The Cox proportional hazards regression model was used to identify prognostic factors that influence in-hospital mortality. A total of 82 ICU patients with confirmed TB were included in the analysis, and 22 deaths were observed during the hospital stay, 21 patients died in the ICU. In the multivariable model adjusted for sex and age, the levels of serum albumin and white blood cell (WBC) count were significantly associated with mortality in TB patients requiring ICU care (all P < 0.01), the hazard ratios were 0.8 (95% confidence interval (CI): 0.7-0.9) per 1 g/l and 1.1 (95% CI: 1.0-1.2) per 1 × 109/l, respectively. In conclusion, in-hospital mortality remains high in TB patients requiring ICU care. Low serum albumin level and high WBC count significantly impact the risk of mortality in these TB patients in China.

The prevalence, diagnosis and surgical risk factors of spinal tuberculosis in children.

OBJECTIVE: To date, the burden of childhood spinal TB in China has not been estimated, and current treatment is hindered by a lack of evidence. This study aimed to review our experience of childhood spinal TB. METHODS: We reviewed the medical records of paediatric patients (≤15 years) admitted for spinal TB (confirmed or possible) at Shandong Provincial Chest Hospital from January 2006 to December 2019. Demographic, clinical, laboratory and radiological data were collected from medical records and analysed retrospectively. RESULTS: Seventy-two patients were diagnosed with spinal TB. 45 were male (62.5%), and 27 female (37.5%), with a mean age of 8.42 ± 4.47 (SD) years. During this 14-year period, the overall prevalence of spinal TB among childhood TB was 4.5%. T-SPOT.TB, AFB smear, mycobacterial culture, TB RT-PCR and biopsies were positive in 29.6%, 14.3%, 23.3%, 43.8% and 88.5% of assayed patients, respectively. The overall surgical rate of the studied patients was 40.3%. The requirement of surgery in childhood spinal TB was associated with pulmonary TB (OR = 4.000, 95% CI: 1.197, 13.367). CONCLUSION: Spinal TB in children cannot be neglected. It remains a severe problem to public health, and more attention should be paid to initiating treatment early.

OBJECTIF: A ce jour, la charge de la tuberculose (TB) vertébrale infantile en Chine n'a pas été estimée et le traitement actuel est entravé par un manque de données. Cette étude visait à passer en revue notre expérience de la TB vertébrale infantile. MÉTHODES: Nous avons examiné les dossiers médicaux des patients pédiatriques (≤15 ans) admis pour une TB vertébrale (confirmés ou possibles) au Shandong Provincial Chest Hospital de janvier 2006 à décembre 2019. Les données démographiques, cliniques, de laboratoire et radiologiques ont été recueillies à partir des dossiers médicaux et analysées rétrospectivement. RÉSULTATS: Soixante-douze patients ont reçu un diagnostic de TB vertébrale. 45 étaient de sexe masculin (62,5%) et 27 de sexe féminin (37,5%), avec un âge moyen de 8,42 ± 4,47 (DS) ans. Au cours de cette période de 14 ans, la prévalence globale de la TB vertébrale dans la TB infantile était de 4,5%. T-SPOT.TB, frottis de BAR, culture mycobactérienne, RT-PCR, TB et biopsies étaient positifs chez 29,6%, 14,3%, 23,3%, 43,8% et 88,5% des patients testés, respectivement. Le taux chirurgical global chez les patients étudiés était de 40,3%. La nécessité d'une intervention chirurgicale dans la TB vertébrale infantile était associée à la TB pulmonaire (OR: 4,000, IC95%: 1,197 - 13,367). CONCLUSION: La TB vertébrale chez l'enfant ne peut pas être négligée. Elle demeure un grave problème de santé publique et il faudrait accorder plus d'attention à l'initiation précoce du traitement.

Thromboembolic and bleeding risk of periprocedural bridging anticoagulation: A systematic review and meta-analysis.

The risk and benefit of periprocedural heparin bridging is not completely clarified. We aimed to assess the safety and efficacy of bridging anticoagulation prior to invasive procedures or surgery. Heparin bridging was associated with lower risks of thromboembolism and bleeding compared to non-bridging. PubMed, Ovid and Elsevier, and Cochrane Library (2000-2016) were searched for English-language studies. Studies comparing interrupted anticoagulation with or without bridging and continuous oral anticoagulation in patients at moderate-to-high thromboembolic risk before invasive procedures were included. Primary outcomes were thromboembolic events and bleeding events. Mantel-Haenszel method and random-effects models were used to analyze the pooled risk ratio (RR) and 95% confidence interval (CI) for thromboembolic and bleeding risks. Eighteen studies (six randomized controlled trials and 12 cohort studies) were included (N = 23 364). There was no difference in thromboembolic risk between bridged and non-bridged patients (RR: 1.26, 95% CI: 0.61-2.58; RCTs: RR: 0.71, 95% CI: 0.23-2.24; cohorts: RR: 1.45, 95% CI: 0.63-3.37). However, bridging anticoagulation was associated with higher risk of overall bleeding (RR: 2.83, 95% CI: 2.00-4.01; RCTs: RR: 2.24, 95% CI: 0.99-5.09; cohorts: RR: 3.09, 95% CI: 2.07-4.62) and major bleeding (RR: 3.00, 95% CI: 1.78-5.06; RCTs: RR: 2.48, 95% CI: 1.29-4.76; cohorts: RR: 3.22, 95% CI: 1.65-6.32). Bridging anticoagulation was associated with increased bleeding risk compared to non-bridging. Thromboembolism risk was similar between two strategies. Our results do not support routine use of bridging during anticoagulation interruption.

Comparison of the efficacy of a bougie and stylet in patients with endotracheal intubation: A meta-analysis of randomized controlled trials.

BACKGROUND: Endotracheal intubation (ETI) is a procedure widely performed for several clinical indications. In typical ETI, an endotracheal tube is placed into a patient's trachea with the help of a malleable metal rod covered with a clear plastic sheath (called a stylet). However, another intubation aid, a bougie (also named a gum elastic bougie or endotracheal tube introducer), was also introduced in the clinical setting to improve the efficacy of conventional ETI. METHODS: This study performed a systematic review and meta-analysis of randomized controlled trials to compare the efficacy of bougie and stylet approaches in ETI. PubMed, Embase, and Cochrane Library databases were searched for studies published before November 2018. Randomized controlled trials comparing the clinical outcomes of bougie and stylet approaches in patients who underwent orotracheal intubation were included. Meta-analyses were conducted by using a random effects model, and treatment efficacy was measured by evaluating the first-attempt success rate and intubation duration. RESULTS: A total of 5 randomized controlled trials and 1,038 patients were included. Although a bougie resulted in a better first-attempt success rate, no significant difference was observed between the approaches (risk ratios, 1.03; 95% confidence interval, 0.85-1.24). Moreover, no significant differences were observed in the intubation duration and esophageal intubation rate between the bougie and stylet approaches. CONCLUSION: Endotracheal intubation performed with a bougie was not superior over ETI performed with a stylet. Therefore, intubation approaches should be selected by considering personal preference and clinician expertise. LEVEL OF EVIDENCE: Systematic review and meta-analysis, level II.

[The influence of benazepril and amlodipine on the expression of secretin and somatostatin in spontaneously hypertensive rats].

OBJECTIVES: Investigate the influence of benazepril and amlodipine on the expression of secretin (PZ) and somatostatin (SS) in spontaneously hypertensive rats (SHR). METHODS: Forty-five SHRs (14 weeks old, male) were randomly assigned into 3 groups (n=15):SHR group, Benazepril group (which was given benazepril 0.90 mg·kg-1·d-1) and Amlodipine group (SHRs were given amlodipine 0.45 mg· kg-1·d-1), taking WistarKyoto(WKY) as normal control (n=15), meanwhile, rats in SHR group and WKY group were given the same volume of distilled water. After 8 weeks of intervention, the expression of protein and mRNA of PZ in duodenum and SS in sinuses ventriculi was detected by enzyme-linked immunoassay and RT-PCR. RESULTS: After 8 weeks of intervention, compared with the WKY group, the expression of protein and mRNA of PZ in duodenum and SS in sinuses ventriculi was increased significantly in SHR group (P<0. 05). Compared with SHR group, the expression of PZ in duodenum and SS in sinuses ventriculi was decreased significantly in Benazepril group and Amlodipine group (P<0.05). Compared with Benazepril group, in Amlodipine group the expression of PZ mRNA in duodenum and SS mRNA in sinuses ventriculi was decreased more significantly (P<0.05). CONCLUSIONS: The regulation disorder of PZ in duodenum and SS in sinuses ventriculi exists in SHR. The antihypertensive effect of benazepril and amlodipine may be realized by regulating the expression of PZ and SS, while the regulation of amlodipine is more obvious than benazepril.

Efficacy after preoperative capecitabine and oxaliplatin (XELOX) versus docetaxel, oxaliplatin and S1 (DOS) in patients with locally advanced gastric adenocarcinoma: a propensity score matching analysis.

BACKGROUND: The aim of this study was to compare the efficacies of the XELOX and DOS regimens as preoperative chemotherapy in patients with locally advanced gastric cancer. METHODS: All cases of locally advanced gastric cancer treated with the XELOX or DOS regimen were reviewed retrospectively. Propensity score matching (PSM) was carried out to reduce selection bias based on age, gender, location, Lauren type, carcinoembryonic antigen level, clinical tumor stage, and clinical node stage. RESULTS: From January 2010 to December 2016, 248 patients were matched; 159 of them received the XELOX regimen and 89 the DOS regimen. The response rates in the XELOX and DOS groups were 34.5 and 38.1%, respectively (P = 0.823). After four cycles of chemotherapy, 111 patients (69.8%) in the XELOX group and 65 patients (73.0%) in the DOS group underwent radical surgery (P = 0.485). The median progression-free survival (33.0 months vs. 18.7 months, P = 0.0356) and the median overall survival (43.8 months vs. 29.1 months, P = 0.0003) were longer for patients who received the DOS regimen than for those who received the XELOX regimen. The occurrence of grade 3 to 4 toxicity was similar in the two groups. CONCLUSIONS: For locally advanced gastric cancer patients, the DOS regimen showed more benefit than the XELOX regimen as preoperative chemotherapy, without any added toxicity effects.

Efficacy of preoperative chemotherapy regimens in patients with initially unresectable locally advanced gastric adenocarcinoma: capecitabine and oxaliplatin (XELOX) or with epirubicin (EOX).

Purpose We assessed the effectiveness of EOX (capecitabine, oxaliplatin and epirubicin) compared with XELOX (capecitabine and oxaliplatin) as preoperative chemotherapy for initially unresectable locally advanced gastric cancer.Methods This is a prospective observational study. Patients with unresectable locally advanced gastric cancer were performed EOX regimen or XELOX regimen at the discretion of the investigators. They were assessed for response every 2 cycles by CT (computed tomography) scan. A multidisciplinary team reassessed resectability after 4 cycles. The primary endpoint was the response rate. Secondary end points included the R0 resection rate, survival and adverse events.Results From November 2008 to May 2015, 242 patients were enrolled; 112 of them were assigned to EOX regimen and 130 to XELOX regimen. The response rates were 33.0% and 33.8% respectively in EOX group and XELOX group (P = 0.997). After 4 cycles of chemotherapy, 63 patients (56.3%) in EOX group and 81 patients (62.3%) in XELOX group received radical operation (P = 0.408). There was no significant difference in progress-free survival (PFS, 12.0m vs. 15.4m, P = 0.925) and overall survival (OS, 25.7m vs. 29.0m, P = 0.783) in two groups. In addition, more adverse effects occurred in EOX group, such as more leucopenia (22.3% vs. 10.0%, P = 0.014), neutropenia (23.2% vs. 11.5%, P = 0.025), fatigue (11.6% vs. 3.8%, P = 0.041) and vomiting (10.7% vs. 2.3%, P = 0.015).Conclusions For unresectable locally advanced gastric cancer patients, XELOX regimen showed similar effects in response rate, radical resection rate and survival benefits, but with less toxicity effects.

Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic review and meta-analysis of recovery outcomes in morbidly obese patients who had undergone general anesthesia. SOURCE: We systematically searched the PubMed, EMBASE™, Cochrane, and Scopus™ databases for randomized controlled trials that evaluated the outcome of anesthesia with desflurane, sevoflurane, isoflurane, or propofol in morbidly obese patients. Using a random effects model, we conducted meta-analyses to assess recovery times (eye opening, hand squeezing, tracheal extubation, and stating name or birth date), time to discharge from the postanesthesia care unit (PACU), and the incidence and severity of postoperative nausea and vomiting (PONV). PRINCIPAL FINDINGS: We reviewed results for 11 trials and found that patients given desflurane took less time: to respond to commands to open their eyes (weighted mean difference [WMD] -3.10 min; 95% confidence interval (CI): -5.13 to -1.08), to squeeze the investigator's hand (WMD -7.83 min; 95% CI: -8.81 to -6.84), to be prepared for tracheal extubation (WMD -3.88 min; 95% CI: -7.42 to -0.34), and to state their name (WMD -7.15 min; 95% CI: -11.00 to -3.30). We did not find significant differences in PACU discharge times, PONV, or the PACU analgesic requirement. CONCLUSION: Postoperative recovery was significantly faster after desflurane than after sevoflurane, isoflurane, or propofol anesthesia in obese patients. No clinically relevant differences were observed regarding PACU discharge time, incidence of PONV, or postoperative pain scores. The systematic review was registered with PROSPERO (CRD42014009480).

Effects of levobupivacaine on isolated rat tracheal smooth muscle.

Levobupivacaine has been developed as a safer alternative to bupivacaine because of its reduced systemic toxicity. However, the effect of directly delivering levobupivacaine into tracheal smooth muscle has not been adequately explored. We performed this study to determine the in vitro effects of levobupivacaine on isolated rat tracheal smooth muscle. A portion of rat trachea 5 mm in length was mounted in 30 ml of Krebs solution in a muscle bath at 37 °C. The following effects of levobupivacaine were assessed: (1) the effect on tracheal smooth muscle resting tension (n = 6), (2) the effect on contraction caused by 10(-6) M methacholine (n = 6) and (3) the effect on electrically induced tracheal smooth muscle contractions (n = 6). Levobupivacaine caused dose-dependent relaxation in the trachealis muscle precontracted with 10(-6) M methacholine. Contraction inhibition was statistically significant when 10(-5) and 10(-4) M levobupivacaine were applied, compared with the contraction inhibition that occurred in the control groups (p < 0.01). A high dose of levobupivacaine also decreased the spike contraction induced by electrical field stimulation. This study indicated that high concentrations of levobupivacaine might antagonize the cholinergic receptors and inhibit parasympathetic function of the trachea.

[Low-Concentration CO2 Adsorption on Polyaniline/Zeolite Y Composites].

Three polyaniline (PANI)/zeolite Y composites with different polyaniline loads, PANI-Y-1, PANI-Y-2 and PANI-Y-3, were prepared by in situ chemical oxidation polymerization method using different amounts of aniline. The structural characteristics of these materials were analyzed by FT-IR and nitrogen adsorption experiment. The adsorption and regeneration properties of the composites for low-concentration CO2 at atmosphere pressure were investigated. Characterization results show that aniline is successfully polymerized in and out side of channels of zeolite Y. The above three materials, whose pores are composed of macropores and mesopores, have specific surface areas of 52, 54 and 35 m2 g -¹, respectively. In addition, a composite with high polyaniline loading has low pore volumes. At 20°C, CO2 adsorption on the three composites and zeolite Y are well fitted with the Logistic model, and the adsorption amount of CO2 with initial concentration of 10% follows an order of PANI-Y-2 (2.09 mmol · g⁻¹) > PANI-Y-3 (1.79 mmol · g⁻¹) > PANI-Y-l (1.07 mmol · g⁻¹) > zeolite Y (0.80 mmol · g⁻¹. The adsorption order of the composites is the result of combined effects from polyaniline amount and specific surface area of adsorbents. With concentrations ranging between 2% and 10% CO2 adsorption amount increases when initial concentration is raised. With adsorption temperature changing from 25° to 6°C, low temperature is advantageous to enhancing CO2 adsorption. For PANI-Y-2, only a low regeneration efficiency of 68% is obtained after four times thermal desorption at 80°C. However, the regeneration efficiency could be increased up to 94% by aqueous ammonia combined with thermal treatment method.

Acute acalculous cholecystitis immediately after gastric operation: case report and literatures review.

Acute acalculous cholecystitis (AAC) is a rare complication of gastric surgery. The most commonly accepted concepts regarding its pathogenesis are bile stasis, sepsis and ischemia, but it has not been well described how to identify and manage this disease in the early stage. We report three cases of AAC in elderly patients immediately after gastric surgery, which were treated with three different strategies. One patient died 42 d after emergency cholecystectomy, and the other two finally recovered through timely cholecystostomy and percutaneous transhepatic gallbladder drainage, respectively. These cases informed us of the value of early diagnosis and proper treatment for perioperative AAC after gastric surgery. We further reviewed reported cases of AAC immediately after gastric operation, which may expand our knowledge of this disease.

Patient-controlled epidural levobupivacaine with or without fentanyl for post-cesarean section pain relief.

PURPOSE: The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study. METHODS: We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion. RESULTS: There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups. CONCLUSION: Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients.

[Clinicopathological features and prognosis of chronic gastric ulcer with early canceration].

OBJECTIVE: To evaluate the clinicopathological features and prognosis of chronic gastric ulcer with early canceration in order to provide useful information for diagnosis and treatment strategies. METHODS: A retrospective review of clinical data and prognosis from 43 patients of chronic gastric ulcer with early canceration from 2003 to 2010 was conducted. These data were compared with those with primary intra-mucosa gastric cancer (type I and II 275 cases, type III 68 cases). RESULTS: In 43 cases of chronic gastric ulcer with early canceration, 30 cases (69.8%) were male, 22 cases (51.2%) were younger than 60 years old. Lesions located in the body or antrum of the stomach in 39 cases (90.7%), were less than 2 cm in 26 cases (60.5%), were undifferentiated type in 23 cases (53.5%), and developed lymph node metastasis in 4 cases (9.3%). Lesions of 4 cases of chronic gastric ulcer with early canceration located in the upper third of the stomach, while those of type III primary intra-mucosal gastric cancer all located in the lower two thirds, and the difference was statistically significant (P<0.01). Compared to type III and type I and II primary intra-mucosal gastric cancer, chronic gastric ulcer with early canceration did not differ in clinicopathological characteristics such as histological type, vascular or lymphatic invasion, and lymph nodes metastasis (all P>0.05). The median follow-up time was 57 months (range 16 to 98 months). The 5-year overall survival was 95.3% in chronic gastric ulcer with early canceration group, similar to that of type I, II (97.4%) or type III (94.5%) primary intra-mucosal gastric cancer group (P>0.05). CONCLUSIONS: The clinicopathological features of chronic gastric ulcer with early canceration are similar to those of primary intra-mucosal gastric cancer. The prognosis is promising for those patients undergoing surgical treatment.

[How to carry out the translational medicine research effectively in gastrointestinal tumors].

As a new concept, the definition of translational medicine remains obscure. The translational medicine connects the bench to bedside, and its importance would be more remarkable. The development of gastrointestinal surgery reflects the idea of translational medicine. To carry out the translational study, the gastrointestinal surgeon must learn how to find subjects from clinical problems, how to collect complete information and tissues, how to collect complete information and tissues, how to collaborate with others from different fields and how to utilize all kinds of resources. By translational studies, gastrointestinal surgeons may further improve the survival of patients with gastrointestinal tumor.

[Optimation the extracting technology of Angelica sinensis by central composite design and response surface methodology].

OBJECTIVE: To optimize the extracting technology from Angelica sinensis by central composite design-response surface methodology. METHODS: On the basis of the single factor,independent variables were ethanol concentrations, solvent ratio and ultrasonic time, while dependent variable was the OD value of extraction rates of ferulic acid and liqustilide. A two-order polynomial equation was fitted to estimate the relationship between independent and dependent variables. Response surface method was used to optimize the extracting process. RESULTS: The optimum extraction conditions for Angelica sinesis were obtained as follows: the extracting solvent was methanol concentrations of 70%, 30 fold solvent, extracting for once and for 40 minutes. The deviation between observed and predicted values was 1.23%. CONCLUSION: The result indicates that the central composite design and response surface methodology is simple, convenient and reliable for optimizing the extraction process of Angelica sinesis with higher precision.

Lipoteichoic acid induces surfactant protein-A biosynthesis in human alveolar type II epithelial cells through activating the MEK1/2-ERK1/2-NF-κB pathway.

BACKGROUND: Lipoteichoic acid (LTA), a gram-positive bacterial outer membrane component, can cause septic shock. Our previous studies showed that the gram-negative endotoxin, lipopolysaccharide (LPS), could induce surfactant protein-A (SP-A) production in human alveolar epithelial (A549) cells. OBJECTIVES: In this study, we further evaluated the effect of LTA on SP-A biosynthesis and its possible signal-transducing mechanisms. METHODS: A549 cells were exposed to LTA. Levels of SP-A, nuclear factor (NF)-κB, extracellular signal-regulated kinase 1/2 (ERK1/2), and mitogen-activated/extracellular signal-regulated kinase kinase (MEK)1 were determined. RESULTS: Exposure of A549 cells to 10, 30, and 50 µg/ml LTA for 24 h did not affect cell viability. Meanwhile, when exposed to 30 µg/ml LTA for 1, 6, and 24 h, the biosynthesis of SP-A mRNA and protein in A549 cells significantly increased. As to the mechanism, LTA enhanced cytosolic and nuclear NF-κB levels in time-dependent manners. Pretreatment with BAY 11-7082, an inhibitor of NF-κB activation, significantly inhibited LTA-induced SP-A mRNA expression. Sequentially, LTA time-dependently augmented phosphorylation of ERK1/2. In addition, levels of phosphorylated MEK1 were augmented following treatment with LTA. CONCLUSIONS: Therefore, this study showed that LTA can increase SP-A synthesis in human alveolar type II epithelial cells through sequentially activating the MEK1-ERK1/2-NF-κB-dependent pathway.