Improvement of the nutritional support management system for patients in intensive care units.

BACKGROUND: Nutritional support for patients hospitalized in the intensive care unit (ICU) is an important part of clinical treatment and care, but there are significant implementation difficulties. AIM: To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling. METHODS: The division of functions, personnel training, system construction, development of an intelligent decision-making software system, quality control, and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients. RESULTS: Following the implementation of the whole process management system, the scores of ICU medical staff's knowledge, attitudes/beliefs, and practices regarding nutritional support were comprehensively enhanced. The proportion of hospital bed-days of total enteral nutrition (EN) in ICU patients increased from 5.58% to 11.46%, and the proportion of EN plus parenteral nutrition increased from 42.71% to 47.07%. The rate of EN initiation within 48 h of ICU admission increased from 37.50% to 48.28%, and the EN compliance rate within 72 h elevated from 20.59% to 31.72%. After the implementation of the project, the Self-rating Anxiety Scale score decreased from 61.07 ± 9.91 points to 52.03 ± 9.02 points, the Self-rating Depression Scale score reduced from 62.47 ± 10.50 points to 56.34 ± 9.83 points, and the ICU stay decreased from 5.76 ± 2.77 d to 5.10 ± 2.12 d. CONCLUSION: The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.

Autoimmune diseases: targets, biology, and drug discovery.

Autoimmune diseases (AIDs) arise from a breakdown in immunological self-tolerance, wherein the adaptive immune system mistakenly attacks healthy cells, tissues and organs. AIDs impose excessive treatment costs and currently rely on non-specific and universal immunosuppression, which only offer symptomatic relief without addressing the underlying causes. AIDs are driven by autoantigens, targeting the autoantigens holds great promise in transforming the treatment of these diseases. To achieve this goal, a comprehensive understanding of the pathogenic mechanisms underlying different AIDs and the identification of specific autoantigens are critical. In this review, we categorize AIDs based on their underlying causes and compile information on autoantigens implicated in each disease, providing a roadmap for the development of novel immunotherapy regimens. We will focus on type 1 diabetes (T1D), which is an autoimmune disease characterized by irreversible destruction of insulin-producing ß cells in the Langerhans islets of the pancreas. We will discuss insulin as possible autoantigen of T1D and its role in T1D pathogenesis. Finally, we will review current treatments of TID and propose a potentially effective immunotherapy targeting autoantigens.

Development and validation of a Cancer Patient Suicidal Ideation Scale.

Aim: To develop a Cancer Patient Suicidal Ideation Scale (CAPASIS) and test its reliability and validity. Patients & methods: An initial CAPASIS was developed. Clinical assessment was conducted using an adjusted initial scale with 239 cancer patients for item reduction and 253 for scale validation. Results: Item selection analyses resulted in 22 items. The revised model fits were acceptable (normal chi-square [χ2/df] = 1.919; standardized root mean residual  = 0.057; root mean square error of approximation = 0.060; goodness fit index = 0.882; adjusted goodness fit index [AGFI] = 0.844; Tucker-Lewis index = 0.898; comparative fit index  = 0.915; incremental fit index  = 0.917). The Cronbach's alpha coefficient was 0.911. Conclusion: The CAPASIS has good validity and reliability, with a six-factor structure of 'entrapment', 'defeat', 'isolation', 'hopelessness', 'burdensomeness' and 'humiliation', which can help identify patients with suicidal ideation.

Yinchenhao decoction attenuates obstructive jaundice-induced liver injury and hepatocyte apoptosis by suppressing protein kinase RNA-like endoplasmic reticulum kinase-induced pathway.

BACKGROUND: Chronic biliary obstruction results in ischemia and hypoxia of hepatocytes, and leads to apoptosis. Apoptosis is very important in regulating the homeostasis of the hepatobiliary system. Endoplasmic reticulum (ER) stress is one of the signaling pathways that induce apoptosis. Moreover, the protein kinase RNA-like endoplasmic reticulum kinase (PERK)-induced apoptotic pathway is the main way; but its role in liver injury remains unclear. Yinchenhao decoction (YCHD) is a traditional Chinese medicine formula that alleviates liver injury and apoptosis, yet its mechanism is unknown. We undertook this study to investigate the effects of YCHD on the expression of ER stress proteins and hepatocyte apoptosis in rats with obstructive jaundice (OJ). AIM: To investigate whether YCHD can attenuate OJ-induced liver injury and hepatocyte apoptosis by inhibiting the PERK-CCAAT/enhancer-binding protein homologous protein (CHOP)-growth arrest and DNA damage-inducible protein 34 (GADD34) pathway and B cell lymphoma/leukemia-2 related X protein (Bax)/B cell lymphoma/leukemia-2 (Bcl-2) ratio. METHODS: For in vivo experiments, 30 rats were divided into three groups: control group, OJ model group, and YCHD-treated group. Blood was collected to detect the indicators of liver function, and liver tissues were used for histological analysis. For in vitro experiments, 30 rats were divided into three groups: G1, G2, and G3. The rats in group G1 had their bile duct exposed without ligation, the rats in group G2 underwent total bile duct ligation, and the rats in group G3 were given a gavage of YCHD. According to the serum pharmacology, serum was extracted and centrifuged from the rat blood to cultivate the BRL-3A cells. Terminal deoxynucleotidyl transferase mediated dUTP nick end-labelling (TUNEL) assay was used to detect BRL-3A hepatocyte apoptosis. Alanine aminotransferase (ALT) and aspartate transaminase (AST) levels in the medium were detected. Western blot and quantitative real-time polymerase chain reaction (qRT-PCR) analyses were used to detect protein and gene expression levels of PERK, CHOP, GADD34, Bax, and Bcl-2 in the liver tissues and BRL-3A cells. RESULTS: Biochemical assays and haematoxylin and eosin staining suggested severe liver function injury and liver tissue structure damage in the OJ model group. The TUNEL assay showed that massive BRL-3A rat hepatocyte apoptosis was induced by OJ. Elevated ALT and AST levels in the medium also demonstrated that hepatocytes could be destroyed by OJ. Western blot or qRT-PCR analyses showed that the protein and mRNA expression levels of PERK, CHOP, and GADD34 were significantly increased both in the rat liver tissue and BRL-3A rat hepatocytes by OJ. The Bax and Bcl-2 levels were increased, and the Bax/Bcl-2 ratio was also increased. When YCHD was used, the PERK, CHOP, GADD34, and Bax levels quickly decreased, while the Bcl-2 levels increased, and the Bax/Bcl-2 ratio decreased. CONCLUSION: OJ-induced liver injury and hepatocyte apoptosis are associated with the activation of the PERK-CHOP-GADD34 pathway and increased Bax/Bcl-2 ratio. YCHD can attenuate these changes.

Labdanes and megastigmanes from Vitex negundo var. heterophylla.

The aromatic plants of Vitex negundo var. heterophylla are not only herb medicine but also a functional food and an industrial crop. Its leaves can be used as a functional food for improving human's health, but the previous studies mainly focused on the volatile constituents, lignans, and iridoids. Our research led to the isolation of four new terpenoids (1-4), together with fifteen known compounds including seven flavonoids (9-15), two jasmonates (7-8) and six terpenoids (5-6, 16-19) from the leaves. Among all these compounds, 1, 2, 11, and 19 exhibited strong inhibitory activity against NO production in lipopolysaccharide (LPS)-induced RAW264.7 macrophage. The anti-inflammatory mechanism of the most active compound (2) is related to the inhibition of iNOS and COX-2, and the suppression of NF-κB pathway. Therefore, terpenoids and flavonoids from the leaves of Vitex negundo var. heterophylla might be used as potential anti-inflammatory candidates for developing medicine or value-added functional food.

Triterpenoids from Ganoderma lucidum and Their Potential Anti-inflammatory Effects.

Ganoderma lucidum, as food, tea, dietary supplement, and medicine, is widely used in China and Eastern Asian countries. In order to discover its anti-inflammatory constituents and provide some references for the usage of G. lucidum and G. sinense, two official species in China, the fruiting bodies of G. lucidum were studied, leading to the isolation of six new triterpenoids (1-6) and 27 known analogues (7-33). Compound 4 exhibited the most potent inhibition on nitric oxide (NO) production induced by lipopolysaccharide (LPS) in RAW264.7 macrophage cells. The production of IL-6 and IL-1ß, as well as the expression of iNOS, COX-2, and NF-κB were dose-dependently reduced by 4. The phosphorylations of IκBα and IKKß in LPS-induced macrophage cells were blocked by 4. Therefore, 4 could be used as a potential anti-inflammatory candidate and the total triterpenoids might be developed as value-added functional food for the prevention of inflammation. In combination of previous studies, it should be cautious for the interchangeable usage of G. lucidum and G. sinense.

Anti-inflammatory Lathyrane Diterpenoids from Euphorbia lathyris.

Six new lathyrane diterpenoids (1-6) and 10 known analogues (7-16), were separated from the seeds of Euphorbia lathyris. The absolute configuration of 1 was determined by X-ray crystallography, and the C-2' configuration of 5 was elucidated by comparing experimental and calculated ECD data. These compounds were studied for their inhibition against nitric oxide (NO) generation induced by lipopolysaccharide in RAW264.7 macrophage cells. Compounds 1-3, 7, 9, 11, 13, 14, and 16 displayed inhibitory effects on NO production, with IC50 values of 2.6-26.0 µM. The new compound 1 (IC50 3.0 ± 1.1 µM), with no obvious cytotoxicity, was selected for further experiments. The production of cytokines such as IL-6 and IL-1ß, as well as the protein expression of iNOS, NF-κB, and phosphorylated IκBα, was reduced by 1 dose-dependently. These results suggested that lathyrane diterpenoids may be used as potential anti-inflammatory agents and are worth being further researched.

Withanolides and aromatic glycosides isolated from Nicandra physaloides and their anti-inflammatory activity.

Two new withanolides (1-2) together with five known ones (3-7), and three known aromatic glycosides (8-10) were isolated from the dried stems and leaves of Nicandra physaloides, an edible and medicinal plant. Their structures were identified by extensive spectroscopic analyses or comparison with literature data. The absolute configuration of 2 was assigned via X-ray crystallography. Compound 1 with a spiroketal moiety is relatively unusual in withanolides. Aromatic glycosides (8-10) showed potent inhibitory activity against LPS-induced nitric oxide production in RAW 264.7 macrophages, with IC50 values from 4.69 to 16.12 µM.

Global protein expression analysis of molecular markers of DS-1-47, a component of implantation-promoting traditional chinese medicine.

This study investigated the molecular markers of DS-1-47, a component of an implantation- promoting traditional Chinese medicine consisting of Astragalus mongholicus, Atractylodes macrocephala, Scutellaria baicalensis and Dipsacales, in an attempt to clarify the molecular mechanism and action targets of DS-1-47. Controlled ovarian stimulation (COS) method was used to establish the implantation dysfunction models of mice. Animals were divided into normal pregnant group, COS model group and DS-1-47 group. Laser capture microdissection-double dimensional electrophoresis-mass spectrum (LCM-DE-MS) was used to analyze the uterine protein molecules that were possibly involved in the promotion of implantation. Twenty-three proteins in DS-1-47 group were significantly changed as compared to those in COS model group, with 7 proteins down-regulated and 16 proteins up-regulated. Except for some constituent proteins, the down-regulated proteins included collagen α-1 (VI) chain, keratin 7, keratin 14, myosin regulatory light chain 12B, myosin light polypeptide 9, heat shock protein ß-7, and C-U-editing enzyme APOBEC-2; the up-regulated proteins included apolipoprotein A-I, calcium regulated protein-3, proliferating cell nuclear antigen, L-xylulose reductase, and calcium binding protein. These 23 proteins that were regulated by DS-1-47 represented a broad diversity of molecule functions. The down-regulated proteins were associated with stress and immune response, and those up-regulated proteins were related to proliferation. It was suggested that these proteins were important in regulating the uterine environment for the blastocyst implantation. By identification of DS-1-47 markers, proteomic analysis coupled with functional assays is demonstrated to be a promising approach to better understand the molecular mechanism of traditional Chinese medicine.

Neamine inhibits growth of pancreatic cancer cells in vitro and in vivo.

Neamine, a non-toxic derivative of neomycin, has recently been shown to have antitumor activities in various types of cancers. However, its effect on pancreatic cancer is still unknown. The study aimed to investigate its antitumor activity on pancreatic cancer and the underlying mechanisms. MTT assay was used to observe the effect of neamine on angiogenin (ANG)-induced AsPC-1 cell proliferation. Tissue microassay and immunofluorescence staining were used to detect the expression of ANG and its nuclear translocation, respectively. Tumor xenografts were established by subcutaneous inoculation of AsPC-1 pancreatic cancer cells into the right flanks of nude mice, and neamine was injected subcutaneously. Immunohistochemistry was done to observe the expression of ANG, CD31 and Ki-67 in tumor xenografts. It was found that neamine blocked the nuclear translocation of ANG effectively and inhibited ANG-induced AsPC-1 cell proliferation in a dose-dependent manner. Neamine had anti-tumor effects on AsPC-1 xenograft models. Consistently, neamine reduced the expression levels of ANG, Ki-67 and CD31 in tumor xenografts. It was concluded that neamine may be a promising agent for treatment of pancreatic cancer.

Relationship between concentrations of IGF-1 and IGFBP-3 and preoperative depression risk, and effect of psychological intervention on outcomes of high-grade glioma patients with preoperative depression in a 2-year prospective study.

Growth factors in the brain are important to depression. We investigated the relationship between serum insulin-like growth factor (IGF-1) and IGF-binding protein-3 (IGFBP-3) concentration and risk of depression and the effect of psychological intervention on outcomes of high-grade glioma patients with preoperative depression. A total of 249 high-grade glioma patients participated in blood sample collection for IGF-1 and IGFBP-3 detection by ELISA and the Hospital Anxiety and Depression Scale testing. The association between IGF-I or IGFBP-3 and depression risk was assessed using conditional logistic regression, and Student's t tests were used to evaluate differences in change of the Karnofsky Performance Status Scale (KPS) in subgroups after performance of psychosocial intervention. The survivals of patients in subgroups were tested by Kaplan-Meier (log-rank test). We found the risk of depression was elevated with increased IGF-I (HR = 6.320, 95% CI 2.456-16.265, top vs. bottom quartile) and IGFBP-3 concentrations (HR = 3.411, 95% CI 1.345-8.648) after adjustment of confounders. KPS was increased significantly in the intervention groups, but not significantly in the usual care groups after performance of psychosocial intervention. The survival of depressed patients in the usual group was significantly worse than those of other subgroups after performance of psychosocial intervention. Depression is prevalent among patients with high-grade gliomas, and factors of the IGF axis are positively associated with risk of depression and might be involved in the etiology of depression in high-grade glioma patients. Depression correlates with quality of life and outcomes of patients. Therefore, some psychological interventions are needed and may help patients to relieve depression and improve the life quality of glioma patients.

[Effect of Kuijieling decoction on proteins expression of IKK-alpha in colonic mucosa of ulcerative colitis model rats].

OBJECTIVE: To explore the changes of protein expression of IKK-alpha as well as the effects of Kuijieling Decoction (KD) on colonic mucosa of ulcerative colitis (UC) model rats. METHODS: UC model rats were induced by TNBS. The rats were randomly divided into six groups: normal control (NC) group, model control (MC) group, Kuijieling low dose (KLD), middle dose (KMD) group, high dose (KHD) group and SASP group. After 10-days' treatment the rats were killed to get their colonic tissues. The positive rate of IKK-alpha expression was detected by immunohistochemical (IHC). RESULTS: The positive rate of IKK-alpha in MC group was significantly higher than that in NC group (P < 0.01). The positive rate of IKK-alpha in KMD group was significantly lower than that in MC group (P < 0.05). The positive rate of IKK-alpha in KHD and SASP group were significantly lower than that in MC group (P < 0.01). CONCLUSION: IKK-alpha may be involved in the pathogenesis of UC, and KD can inhibit positive rate of IKK-alpha in colonic mucosa of UC model rats induced by TNBS. The inhibitory effects of KD on UC may be associated with this.

catena-Poly[[(nitrato-κO,O')silver(I)]-µ-1,2-bis-(diphenyl-phosphino)ethane-κP:P'].

In the title chain compound, [Ag(NO(3))(C(26)H(24)P(2))](n), the bis-(diphenyl-phosphino)ethane (dppe) units link the Ag(+) ions into chains along [001]. A nitrate anion is coordinated to the Ag atom. There is a centre of symmetry at the mid-point of the ethane C-C bond and a twofold rotation axis passes through the Ag, N and terminal O atoms. Each Ag atom is four-coordinated in a distorted tetra-hedral geometry by two O atoms of the nitrate anion and two P atoms of dppe ligands. The two aromatic rings are oriented at a dihedral angle of 73.77 (3)°.