Influence of the Pre-shock State on the Prognosis of Medical Patients with Sepsis: A Retrospective Cohort Study.

Objective: To investigate the effects of the pre-shock state on the mortality of patients with sepsis. Methods: We enrolled patients with sepsis admitted to the medical intensive care unit of a tertiary care university hospital. These patients were then classified into three groups: sepsis, pre-shock state, and septic shock. The primary outcome was the 28-day mortality rate. The secondary outcomes were the 90-day, 180-day, and 1-year mortality rates. Results: A total of 303 patients (groups: sepsis 135 [44.6%]), pre-shock state (93 [30.7%]), and septic shock (75 [24.8%]) completed the 1-year follow-up. The mortality rates at 28 days, 90 days, and 180 days and 1 year were significantly higher in the pre-shock state group than those of the sepsis group, but significantly lower than those in the septic shock group, especially among older patients. When compared with the pre-shock state group, the sepsis group had significantly lower mortality risks at 28 days, 90 days, and 180 days and 1 year, whereas the sepsis shock group had higher mortality risks at these time points. Conclusion: The mortality rates of patients in the pre-shock state were notably different from those of patients with sepsis or septic shock. The introduction of a modified sepsis severity classification, which includes sepsis, pre-shock state, and septic shock, could offer valuable additional prognostic information.

Research progress of CO2 oxidative dehydrogenation of propane to propylene over Cr-free metal catalysts.

CO2-assisted oxidative dehydrogenation of propane (CO2-ODHP) is an attractive strategy to offset the demand gap of propylene due to its potentiality of reducing CO2 emissions, especially under the demands of peaking CO2 emissions and carbon neutrality. The introduction of CO2 as a soft oxidant into the reaction not only averts the over-oxidation of products, but also maintains the high oxidation state of the redox-active sites. Furthermore, the presence of CO2 increases the conversion of propane by coupling the dehydrogenation of propane (DHP) with the reverse water gas reaction (RWGS) and inhibits the coking formation to prolong the lifetime of catalysts via the reverse Boudouard reaction. An effective catalyst should selectively activate the C-H bond but suppress the C-C cleavage. However, to prepare such a catalyst remains challenging. Chromium-based catalysts are always applied in industrial application of DHP; however, their toxic properties are harmful to the environment. In this aspect, exploring environment-friendly and sustainable catalytic systems with Cr-free is an important issue. In this review, we outline the development of the CO2-ODHP especially in the last ten years, including the structural information, catalytic performances, and mechanisms of chromium-free metal-based catalyst systems, and the role of CO2 in the reaction. We also present perspectives for future progress in the CO2-ODHP.

Untreated Prior Pulmonary Tuberculosis Adversely Affects Pregnancy Outcomes in Infertile Women Undergoing in vitro Fertilization and Embryo Transfer: A Large Retrospective Cohort Study.

OBJECTIVE: Prior pulmonary tuberculosis (PTB) on chest X-ray (CXR) was commonly found in infertile patients receiving examinations before in vitro fertilization and embryo transfer (IVF-ET). It was unclear whether untreated PTB would affect pregnancy outcomes after IVF-ET. METHOD: We conducted a retrospective cohort study of 14,254 infertile patients who had received IVF-ET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth, clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups. RESULTS: The untreated PTB group had significantly lower clinical pregnancy (31.7% vs. 38.1%) and live birth (23.8% vs. 30.6%) rates than the non-PTB group (both P < 0.001). Multivariate analysis revealed that untreated PTB was a risk factor for decreased live birth rate [odds ratio ( OR), 0.80; 95% confidence interval ( CI), 0.66-0.98; P = 0.028] in all patients and for increased miscarriage ( OR, 4.19; 95% CI, 1.69-10.39; P = 0.002) and decreased live birth ( OR, 0.45; 95% CI, 0.24-0.83; P = 0.011) rates in patients with unexplained infertility. CONCLUSIONS: Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.

Imbalance of osteoprotegerin/receptor activator of nuclear factor-κB ligand and oxidative stress in patients with obstructive sleep apnea-hypopnea syndrome.

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with a higher prevalence of osteoporosis. However, the underlying mechanisms linking OSAHS with bone loss are still unclear. The aim of this study was to investigate the changes of receptor activator of nuclear factor-κB ligand (RANKL, an osteoclastogenesis-promoting factor) and osteoprotegerin (OPG, the decoy receptor for RANKL), oxidative stress and bone metabolism markers in OSAHS, in order to understand the potential mechanisms underlying bone loss in OSAHS patients. METHODS: Forty-eight male patients with OSAHS, confirmed by polysomnography (PSG) study, were enrolled. Twenty male subjects who were confirmed as not having OSAHS served as the controls. The subjects' bone mineral density (BMD) was assessed in lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA). Blood samples were collected from all subjects for measurement of RANKL, OPG, the bone formation marker bone-specific alkaline phosphatase (BAP), the bone resorption marker tartrate-resistant acid phosphatase 5b (TRAP-5b), and total antioxidant capacity (TAOC). RESULTS: The BMD and the T-score of the femoral neck and the lumbar spine were significantly lower in OSAHS patients as compared to the control group (P < 0.05). The serum level of BAP was significantly decreased in the OSAHS group (15.62 ±â€Š5.20 µg/L) as compared to the control group (18.83 ±â€Š5.50 µg/L, t = -2.235, P < 0.05), while the levels of TRAP-5b did not differ between the two groups (t = -1.447, P > 0.05). The serum level of OPG and the OPG/RANKL ratio were lower in the OSAHS group compared to the control group (both P < 0.05). TAOC level was also decreased significantly in the OSAHS group (P < 0.05). Correlation analysis showed that the TAOC level was positively correlated with BAP in the OSAHS group (r = 0.248, P = 0.04), but there were no correlations between TAOC and the BMD or the T-scores. The correlations between the level of OPG (or the OPG/RANKL ratio) and BMD or TAOC did not reach significance. CONCLUSION: In OSAHS patients, lower levels of TAOC were associated with decreased bone formation, suggesting a role of oxidative stress in bone loss, while the role of OPG/RANKL imbalance in bone metabolism in OSAHS needs further evaluation.

Peripheral Tc17 and Tc17/Interferon-γ Cells are Increased and Associated with Lung Function in Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by progressive loss of lung function and local and systemic inflammation, in which CD8+ T-cells are believed to play a key role. Activated CD8+ T-cells differentiate into distinct subpopulations, including interferon-γ (IFN-γ)-producing Tc1 and interleukin (IL)-17-producing Tc17 cells. Recent evidence indicates that Tc17 cells exhibit considerable plasticity and may convert into IL-17/IFN-γ-double producing (Tc17/IFN-γ) cells when driven by inflammatory conditions. The aim of this study was to investigate the Tc17/IFN-γ subpopulation in peripheral blood of patients with COPD and to evaluate their potential roles in this disease. METHODS: Peripheral blood samples were collected from 15 never-smokers, 23 smokers with normal lung function, and 25 patients with COPD (Global Initiative for Chronic Obstructive Lung Disease 2-4). Proportions of the IL-17/IFN-γ-double expressing subpopulation were assessed using flow cytometry. Plasma concentrations of cytokines favoring Tc17/IFN-γ differentiation were measured by enzyme-linked immunosorbent assay. RESULTS: Patients with COPD had higher proportions of Tc17 cells and Tc17/IFN-γ cells in the peripheral blood than smokers and never-smokers. The plasticity of Tc17 cells was higher than that of Th17 cells. The percentages of Tc17 cells and Tc17/IFN-γ cells showed negative correlations with forced expiratory volume in 1 s % predicted value (r = -0.418, P = 0.03; r = -0.596, P = 0.002, respectively). The plasma concentrations of IL-6, transforming growth factor-ß1, and IL-12 were significantly higher in patients with COPD compared with smokers and never-smokers. CONCLUSIONS: Peripheral Tc17 cells are increased and more likely to convert to Tc17/IFN-γ cells in COPD, suggesting that Tc17 cell plasticity may be involved in persistent inflammation of the disease.

[Allergic bronchopulmonary aspergillosis in patients with chronic obstructive pulmonary disease: report of 3 cases].

OBJECTIVE: To improve the clinical knowledge on allergic bronchopulmonary aspergillosis (ABPA) combined with COPD by report of cases. METHODS: We retrospectively analyzed the clinical information of 3 cases of ABPA combined with COPD diagnosed in our hospital from Jan. 2009 to Dec. 2012. RESULTS: The 3 patients were all males, and aged from 68 to 82 years. The main complaints of all the patients were exertional dyspnea, cough and sputum production, with episodes of wheezing. All patients denied the history of allergic diseases, e.g., asthma, rhinitis, sinusitis, eczema, and family history of asthma. They all had a history of heavy smoking. The pulmonary function tests indicated obstructive impairment, and the ratio of FEV1 to FVC (FEV1/FVC) after bronchodilators were 30%, 33% and 43%, respectively, with no significant bronchodilator reversibility, which were consistent with the diagnostic criteria for COPD, with 1 case in GOLD grade III and 2 cases in GOLD grade IV based on the GOLD spirometric criteria for COPD severity. Lung HRCT showed emphysema with or without bulla formation. All cases showed immediate positive response to Aspergillus antigen by skin prick test (SPT), increased serum total IgE > 1000 kU/L, increased serum level of Aspergillus specific IgE (>0.35 kU/L) and IgG (>40 mg/L). Central bronchiectasis was also evident on HRCT scan in the 3 patients. In addition, the eosinophil percentage in peripheral blood was all >5%. Pulmonary infiltrates, brown phlegm plugs, and growth of Aspergillus fumigatus were also noted in some cases. After the diagnosis of ABPA, the patients were all given oral prednisone therapy, with notable improvement in dyspnea and FEV1. CONCLUSIONS: ABPA in COPD is uncommon, but early identification and initiation of systemic corticosteroid therapy can lead to improvement in symptoms and prognosis. For COPD patients with recurrent attacks of wheezing or are unresponsive to combination therapy of inhaled long-acting bronchodilators and corticosteroids, concurrent ABPA should be suspected and investigated accordingly.

[IgG4-related lung disease: a case report and review of the literature].

OBJECTIVE: To describe the clinical features of IgG4-related lung disease. METHOD: The clinical symptoms, laboratory tests, radiographic patterns, histopathological features and therapeutic management of a patient with IgG4-related lung disease were described and the literatures were reviewed. RESULTS: A 41-year-old male without significant symptoms was admitted to our department because of diffuse opacities on regular X-ray examination. Chest HRCT revealed diffuse ground-glass opacities (GGOs) and reticular opacities in both lungs, predominantly in the middle fields. Thoracoscopic lung biopsy was performed, and pathological examination of the lung tissues found massive lympho-plasma cell infiltration and collagen deposition along the alveolar septa and bronchovascular bundles on HE staining. Obliterative phlebitis and thickening of alveolar septa were observed. IgG4 immunostaining revealed predominant IgG4(+) plasma cells. IgG4-related lung disease was diagnosed combined with elevation of serum IgG4 concentration (3.07 g/L). The patient received oral prednisone at the dose of 30 mg per day for one month and then the dose was tapered. Four months later a CT scan revealed that the GGOs disappeared and only some reticular opacities and honeycombing changes remained. The serum IgG4 concentration decreased to 1.99 g/L. Twenty-one articles with 65 cases of IgG4-related lung disease were collected through PubMed search engine. Extrapulmonary organs were involved in 38 cases, especially the pancreas. Serum IgG4 concentrations were assessed in 36 cases and elevated in 34. Four radiographic patterns were identified: solid nodule type (55.4%), alveolar interstitial type (26.2%), bronchovascular type (13.8%) and round-shaped GGO type (4.6%). Glucocorticoids were prescribed to 23 patients with a favorable response except one treatment failure. CONCLUSION: IgG4-related lung disease is a rare disorder and easily overlooked in clinical practice. The lung maybe the only target organ, but extrapulmonary organ involvement is the most common discoveries. The diagnosis of IgG4-related lung disease depends on the elevation of serum IgG4 and characteristic histopathological features. Glucocorticoid therapy is very effective and most patients have a good prognosis.

Structural and thermal characterization of hemicelluloses isolated by organic solvents and alkaline solutions from Tamarix austromongolica.

Three organosolv and three alkaline hemicellulosic fractions were prepared from lignocellulosic biomass of the fast-growing shrub Tamarix austromongolica (Tamarix Linn.). Sugar analysis revealed that the organosolv-soluble fractions contained a higher content of glucose (33.7-6.5%) and arabinose (14.8-5.6%), and a lower content of xylose (62.2-54.8%) than the hemicellulosic fractions isolated with aqueous alkali solutions. A relatively high concentration of alkali resulted in a decreasing trend of the xylose/4-O-methyl-D-glucuronic acid ratio in the alkali-soluble fractions. The results of NMR analysis supported a major substituted structure based on a linear polymer of ß-(1→4)-linked d-xylopyranosyl residues, having ramifications of α-L-arabinofuranose and 4-O-methyl-D-glucuronic acid residues monosubstituted at O-3 and O-2, respectively. Thermogravimetric analysis revealed that one step of major mass loss occurred between 200-400°C, as hemicelluloses devolatilized with total volatile yield of about 55%. It was found that organosolv-soluble fractions are more highly ramified, and showed a higher thermal stability than the alkali-soluble fractions.

Comparative study of alkali-soluble hemicelluloses isolated from bamboo (Bambusa rigida).

The physicochemical properties and structural characteristics of seven alkali-soluble hemicellulosic preparations were determined. These were extracted from bamboo (Bambusa rigida) with 1M NaOH, KOH, LiOH, NH(3)·H(2)O, (CH(3)CH(2))(3)N, Ca(OH)(2), Ba(OH)(2), respectively, at 50°C for 3h, were comparatively studied. Sugar analysis showed that these hemicelluloses contained d-xylose as the major constituent, along with d-glucose and l-arabinose in noticeable amounts. Uronic acids, principally 4-O-methyl-d-glucuronic acid, occurred in a small amount. Furthermore, based on the sugar analysis and FTIR and NMR spectroscopy, it can be concluded that the hemicelluloses consist of a backbone of ß-(1→4)-linked d-xylopyranosyl units having branches of arabinose and 4-O-methyl-d-glucuronic acid. Nitrobenzene oxidation revealed that the hemicelluloses obtained are mostly free of bound lignins. Moreover, it is noteworthy that hemicelluloses isolated with the different alkaline solutions presented different chemical compositions and slightly dissimilar structural features, indicating that alkalinity played an important role in cleaving the chemical linkages between the hemicelluloses and the lignins.

[Sarcoidosis with upper airway involvement as the presenting symptoms: case report and literature review].

OBJECTIVE: To investigate the clinical characteristics of sarcoidosis with upper airway (including nose/paranasal sinus, pharynx, larynx and middle ear) involvement as the presenting symptoms, and therefore to minimize the misdiagnosis of sarcoidosis with special manifestations. METHODS: Four cases of sarcoidosis with upper airway involvement as the presenting symptoms diagnosed at our hospital were described. The clinical data were analyzed and related literatures were reviewed. RESULTS: Three female patients aged 52, 53, 34 years and one 15-year-old male patient, with the main complaints as "mycteric mass", "chronic otitis media", "hoarseness" and "chronic tonsillitis" respectively, were referred to our hospital for further evaluation. The diagnosis of sarcoidosis was finally confirmed by biopsy of bronchial mucous membrane, enlarged peripheral lymph nodes, and otorhinolaryngological lesions. Physical examination and imaging findings showed involvements of the lungs and/or the lymph nodes in 3 patients. Seven Chinese articles about upper airway sarcoidosis (all involving the nose) were found after literature search with "sarcoidosis" as the key word at the CNKI database (1915 - 2011). English literature search with the same key word at "Pubmed" showed that the rate of upper airway involvement in sarcoidosis varied from 2.3% - 6.0%, mostly concurrent with thoracic and lymph node diseases, whereas cases of sarcoidosis presenting with otorhinolaryngological symptoms were occasionally reported. CONCLUSIONS: Although upper airway sarcoidosis was rare, it may be the cause of chronic otorhinolaryngological disease which responded poorly to routine treatments. Careful collection of medical history, physical examination and necessary accessory examinations, especially better understanding of the exceptional manifestations of sarcoidosis, can help to minimize misdiagnosis and therefore to improve the prognosis of the patients.

[A comparative clinical analysis of thoracic sarcoidosis and multi-organ sarcoidosis].

OBJECTIVE: To investigate the clinical characteristics of thoracic sarcoidosis compared with multi-organ sarcoidosis. METHODS: The clinical data of 24 patients with thoracic sarcoidosis and 29 patients with multi-organ sarcoidosis histologically diagnosed at Beijing Tongren Hospital from 1995 to 2010 were retrospectively analyzed. The demographic data, clinical manifestations, diagnostic procedures, involved organs, serum angiotensin converting enzyme (ACE) levels, lung functions, and cellular characteristics of bronchoalveolar lavage fluid (BALF) were compared. RESULTS: No difference was found in the age of onset between the 2 groups [(49 ± 12), (48 ± 11) years old; t = 0.114, P > 0.05]. Multi-organ sarcoidosis was more frequent in females compared with thoracic sarcoidosis (13/24, 24/29; χ² = 5.094, P < 0.05), and 72.41% of the patients with multi-organ disease were females above 40 years old. The patients with thoracic sarcoidosis mostly presented first to respiratory physicians or chest surgeons, often with the symptoms of lung involvement. The manifestations of multi-organ sarcoidosis varied considerably and the patients might present to any clinical departments. Sarcoidosis with rare involvement of organs as the presenting symptoms was easy to be misdiagnosed. A higher incidence of systemic constitutional symptoms (25.0%, 58.6%; χ² = 6.043, P < 0.05) and a longer duration for definite diagnosis [1.75 (0.625 - 3.000), 6 (0 - 40) months; Z = -3.377, P < 0.01] were found in patients with multi-organ sarcoidosis compared with thoracic sarcoidosis. There was no difference in the serum ACE level between the 2 groups [(72 ± 33), (75 ± 59) U/L; t = -0.193, P > 0.05]. Although forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC), FEV1 %predicted (pred), FVC%pred and total lung capacity (TLC)%pred showed no difference (t = 0.134 - 0.683, P > 0.05), the diffusing capacity of the lung of carbon monoxide (D(LCO))%pred decreased more remarkably in multi-organ sarcoidosis [(84 ± 8), (69 ± 21); t = 2.674, P < 0.05]. The total cell count, alveolar lymphocyte percentage and CD4/CD8 ratio of BALF demonstrated no significant difference between the 2 groups (t = -0.628 - -0.367, P > 0.05), but the neutrophil percentage was significantly higher in multi-organ sarcoidosis compared with thoracic sarcoidosis [(10.9 ± 4.9)%, (5.1 ± 2.1)%; t = -4.187, P < 0.01]. CONCLUSIONS: Compared with thoracic sarcoidosis, multi-organ sarcoidosis seemed to be more common in females and more serious. Increased percentage of neutrophils in BALF may be a suggestive index for multiple organ involvements.