Association between lactic acidosis and multiple organ dysfunction syndrome after cardiopulmonary bypass.

Background: The relationship between hyperlactatemia and prognosis after cardiopulmonary bypass (CPB) is controversial, and some studies ignore the presence of lactic acidosis in patients with severe hyperlactacemia. This study explored the association between lactic acidosis (LA) and the occurrence of multiple organ dysfunction syndrome (MODS) after cardiopulmonary bypass. Methods: This study was a post hoc analysis of patients who underwent cardiac surgery between February 2017 and August 2018 and participated in a prospective study at Taizhou Hospital. The data were collected at: ICU admission (H0), and 4, 8, 12, 24, and 48 h after admission. Blood lactate levels gradually increased after CPB, peaking at H8 and then gradually decreasing. The patients were grouped as LA, hyperlactatemia (HL), and normal control (NC) based on blood test results 8 h after ICU admission. Basic preoperative, perioperative, and postoperative conditions were compared between the three groups, as well as postoperative perfusion and oxygen metabolism indexes. Results: There were 22 (19%), 73 (64%), and 19 (17%) patients in the LA, HL, and NC groups, respectively. APACHE II (24h) and SOFA (24h) scores were the highest in the LA group (P < 0.05). ICU stay duration was the longest for the LA group (48.5 (42.5, 50) h), compared with the HL (27 (22, 48) h) and NC (27 (25, 46) h) groups (P = 0.012). The LA group had the highest incidence of MODS (36%), compared with the HL (14%) and NC (5%) groups (P = 0.015). In the LA group, the oxygen extraction ratio (O2ER) was lower (21.5 (17.05, 32.8)%) than in the HL (31.3 (24.8, 37.6)%) and the NC group (31.3 (29.0, 35.4) %) (P = 0.018). In the univariable analyses, patient age (OR = 1.054, 95% CI [1.003-1.109], P = 0.038), the LA group (vs. the NC group, (OR = 10.286, 95% CI [1.148-92.185], P = 0.037), and ΔPCO2 at H8 (OR = 1.197, 95% CI [1.022-1.401], P = 0.025) were risk factor of MODS after CPB. Conclusions: We speculated that there was correlation between lactic acidosis and MODS after CPB. In addition, LA should be monitored intensively after CPB.

Long-term oral administration of hyperoside ameliorates AD-related neuropathology and improves cognitive impairment in APP/PS1 transgenic mice.

Alzheimer's disease (AD) is a highly prevalent neurodegenerative disorder characterized by the pathological hallmarks of ß-amyloid plaque deposits, tau pathology, inflammation, and cognitive decline. Hyperoside, a flavone glycoside isolated from Rhododendron brachycarpum G. Don (Ericaceae), has neuroprotective effects against Aß both in vitro and in vivo. However, whether hyperoside could delay AD pathogenesis remains unclear. In the present study, we observed if chronic treatment with hyperoside can reverse pathological progressions of AD in the APP/PS1 transgenic mouse model. Meanwhile, we attempted to elucidate the molecular mechanisms involved in regulating its effects. After 9 months of treatment, we found that hyperoside can improve spatial learning and memory in APP/PS1 transgenic mice, reduce amyloid plaque deposition and tau phosphorylation, decrease the number of activated microglia and astrocytes, and attenuate neuroinflammation and oxidative stress in the brain of APP/PS1 mice. These beneficial effects may be mediated in part by influencing reduction of BACE1 and GSK3ß levels. Hyperoside confers neuroprotection against the pathology of AD in APP/PS1 mouse model and is emerging as a promising therapeutic candidate drug for AD.

Dynamics of peripheral immune cells and their HLA-G and receptor expressions in a patient suffering from critical COVID-19 pneumonia to convalescence.

OBJECTIVES: Host immune responses are indispensable to combat the disease. We report the dynamics of peripheral immune cells, cytokines, and human leucocyte antigen-G (HLA-G) and its receptor expressions in a patient suffering from critical COVID-19 pneumonia to convalescence. METHODS: Clinical data of the patient were collected from medical records. The expressions of HLA-G and receptors ILT2, ILT4 and KIR2DL4 in peripheral immune cells were measured with flow cytometry. RESULTS: From critical COVID-19 to the convalescent stage, early lymphopenia was improved (median: 0.6 × 109 L-1 vs. 0.9 × 109 L-1, P = 0.009), and an obvious fluctuation in WBC and neutrophil counts was observed. Initially, low levels of CD4+ T cells (from 120 to 528 µL-1) and CD8+ T cells (from 68 to 362 µL-1) gradually increased to normal levels. Meanwhile, high IL-6 (from 251.8 to 6.32 pg mL-1), IL-10 (from 39.53 to 5.21 pg mL-1) and IFN-γ (from 13.55 to 3.16 pg mL-1) levels decreased, and IL-4 (from 2.36 to 3.19 pg mL-1) and TNF-α (from 2.27 to 20.2 pg mL-1) levels increased quickly when the viral RNA returned negative. Moreover, the percentage of HLA-G+ T cells, B cells and monocytes follows high-low-high pattern, while the percentage of receptors ILT2-, ILT4- and KIR2DL4-expressing cells remained relatively stable. CONCLUSION: Our findings provide valuable information on the dynamics of early peripheral immunological responses in SARS-CoV-2 infection. CD4+ and CD8+ T cells, cytokines and HLA-G+ immune cells are associated with the natural history of the critical COVID-19 patient; however, future studies are necessary.

[Development history of acupuncture and moxibustion diagnosis and treatment institutions since the founding of the People's Republic of China].

The development process of acupuncture and moxibustion diagnosis and treatment institutions since the founding of the People's Republic of China is summarized and analyzed. The main forms of acupuncture and moxibustion diagnosis and treatment institutions have shifted from the individual, joint clinic and outpatient department of acupuncture and moxibustion in the early years of the founding of the People's Republic of China to the present acupuncture and moxibustion departments in Chinese medicine hospitals and general hospitals.The construction and development of public and private acupuncture and moxibustion hospital and key specialty of acupuncture and moxibustion fully expand the clinical application of acupuncture and moxibustion therapy. In the future, the development of acupuncture and moxibustion diagnosis and treatment institutions should highlight its own features to satisfy the requirements of different levels of society.

Correction to: Scored minor criteria for severe community-acquired pneumonia predicted better.

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Scored minor criteria for severe community-acquired pneumonia predicted better.

BACKGROUND: Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality, but the major problem associated with IDSA/ATS minor criteria might be a lack of consideration of weight in prediction in clinical practice. Would awarding different points to the presences of the minor criteria improve the accuracy of the scoring system? It is warranted to explore this intriguing hypothesis. METHODS: A total of 1230 CAP patients were recruited to a retrospective cohort study. This was tested against a prospective two-center cohort of 1749 adults with CAP. 2 points were assigned for the presence of PaO2/FiO2 ≤ 250 mmHg, confusion, or uremia on admission and 1 point for each of the others. RESULTS: The mortality rates, and sequential organ failure assessment (SOFA) and pneumonia severity index (PSI) scores increased significantly with the numbers of IDSA/ATS minor criteria present and minor criteria scores. The correlations of the minor criteria scores with the mortality rates were higher than those of the numbers of IDSA/ATS minor criteria present. As were the correlations of the minor criteria scores with SOFA and PSI scores, compared with the numbers of IDSA/ATS minor criteria present. The pattern of sensitivity, specificity, positive predictive value, and Youden's index of scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria for prediction of mortality was the best in the retrospective cohort, and the former was better than the latter. The validation cohort confirmed a similar pattern. The area under the receiver operating characteristic curve of scored minor criteria was higher than that of IDSA/ATS minor criteria in the retrospective cohort, implying higher accuracy of scored version for predicting mortality. The validation cohort confirmed a similar paradigm. CONCLUSIONS: Scored minor criteria orchestrated improvements in predicting mortality and severity in patients with CAP, and scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria might be more valuable cut-off value for severe CAP, which might have implications for more accurate clinical triage decisions.

Carbazole Alkaloids from Clausena anisum-olens: Isolation, Characterization, and Anti-HIV Evaluation.

Two new carbazole alkaloids (1,2) and six known carbazole alkaloids (3-8) were isolated from Clausena anisum-olens. Their structures were elucidated based on extensive spectroscopic analysis. All isolated compounds (1-8) were evaluated for their anti-HIV effects on virus replication in MT-4 lymphocytes infected by HIV-1NL4-3 Nanoluc-sec virus, and new carbazole alkaloid 1 exhibited anti-HIV activity with an EC50 value of 2.4 µg/mL and SI of 7.1.

Priority for Treatment and Intensive Care of Patients With Non-Severe Community-Acquired Pneumonia.

BACKGROUND: The Infectious Disease Society of America/the American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is unclear whether the patients with non-severe CAP meeting the minor criteria most strongly associated to mortality should have the priority for treatment and intensive care. It is warranted to explore this intriguing hypothesis. METHODS: A retrospective cohort study of 1230 patients with CAP was performed. This was tested against a prospective 2-center cohort of 1749 adults with CAP. RESULTS: The patients with CAP fulfilling the predictive findings most strongly associated to mortality, i.e. PaO2/FiO2 ≤ 250 mm Hg, confusion, and uremia, showed higher mortality rates than those not fulfilling the predictive findings in subgroup analyses of the retrospective cohort. The more the number of predictive findings present, the higher the mortality rates. The prospective cohort confirmed a similar pattern. Interestingly, the patients with non-severe CAP meeting the predictive findings demonstrated unexpectedly higher mortality rates compared with the patients with severe CAP not meeting the predictive findings in the prospective cohort (P = 0.003), although there only existed death of an uptrend in the retrospective cohort. Two similar and intriguing paradigms about sequential organ failure assessment (SOFA) scores and pneumonia severity index (PSI) scores were confirmed in the 2 cohorts. CONCLUSIONS: The patients with non-severe CAP fulfilling the predictive findings most strongly associated to mortality demonstrated higher SOFA and PSI scores and mortality rates, and might have the priority for treatment and intensive care.

[Effect of Electroacupuncture at "Shenmen" (HT 7)- "Tongli" (HT 5) of Heart Meridian on Neuronal Activities in Paraventricular Nucleus of Hypothalamus in Myocardial Ischemia Rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) stimulation of "Shenmen" (HT 7) - "Tongli" (HT 5) segment of the Heart Meridian on neuronal electrical activities of hypothalamic paraventricular nucleus (PVN) in rats with myocardial ischemia (MI), so as to investigate its possible mechanism underlying improvement of MI. METHODS: Thirty-two SD rats were randomly divided into sham control, model, HT 7-HT 5 and "Taiyuan" (LU 9)- "Lieque" (LU 7) groups (n=8 in each group). EA preconditioning (2 Hz, 1 V, 20 min) was applied to bilateral HT 7-HT 5 and bilateral LU 9-LU 7, respectively, once everyday for 7 days. The electrical activities of the right PVN region were recorded by the implanted microelectrode array(2×4)and Plexon multi-channel acquisition system. Cluster analysis of neuronal signals was carried out by Offline Sorter software. The discharge waveforms, autocorrelation and cross-correlation of neuronal activities were analyzed by using Neuro Explorer software. RESULTS: Cluster analysis of neuronal signals showed that 2, 2, 1 and 1 interneuron in the sham, model, HT 7-HT 5, and LU 9-LU 7 groups, and 3 pyramidal neurons in the HT 7-HT 5 were acquired. Cross correlation analysis showed that the SPK 02 a and SPK 02 b neurons of the HT 7-HT 5 group had an inhibitory relationship. The total discharge frequency was significantly increased in the model group relevant to the sham group (P<0.01), and was markedly lower in the HT 7-HT 5 group than in the model group and LU 9-LU 7 group (P<0.01). Real-time spectrum analysis showed that the local field potential spectrum energy of the HT 7-HT 5 group was significantly lower than that of the model group and the LU 9-LU 7 group. CONCLUSION: EA of HT 7-HT 5 segment of the Heart Meridian can inhibit the electrical activity of interneuron and activate the electrical activity of pyramidal neuron in PVN region, and an inhibitory relationship exists between the interneuron and pyramidal neuron in MI rats, which may be a mechanism of EA in regulating activities of the ischemic heart.

Electroacupuncture modulates the activity of the hippocampus-nucleus tractus solitarius-vagus nerve pathway to reduce myocardial ischemic injury.

The hippocampus is involved in the regulation of the autonomic nervous system, together with the hypothalamus and brainstem nuclei, such as the paraventricular nucleus and nucleus tractus solitarius. The vagus nerve-nucleus tractus solitarius pathway has an important role in cardiovascular reflex regulation. Myocardial ischemia has been shown to cause changes in the autonomic nervous system, affecting the dynamic equilibrium of the sympathetic and vagal nerves. However, it remains poorly understood how the hippocampus communicates with brainstem nuclei to regulate the autonomic nervous system and alleviate myocardial ischemic tissue damage. A rat model of acute myocardial ischemia (AMI) was made by ligating the left anterior descending branch of the coronary artery. Three days before ischemia, the hippocampal CA1 region was damaged. Then, 3 days after ischemia, electroacupuncture (EA) at Shenmen (HT7)-Tongli (HT5) was performed (continuous wave, 1 mA, 2 Hz, duration of 30 minutes). Cluster analysis of firing patterns showed that one type of neuron was found in rats in the sham and AMI groups. Three types of neurons were observed in the AMI + EA group. Six types of neurons were found in the AMI + EA + Lesion group. Correlation analysis showed that the frequency of vagus nerve discharge in each group was negatively correlated with heart rate (HR) (P < 0.05, r = -0.424), and positively correlated with mean arterial pressure (MAP) (P < 0.05, r = 0.40987) and the rate-pressure product (RPP) (P < 0.05, r = 0.4252). The total frequency of the nucleus tractus solitarius discharge in each group was positively correlated with vagus nerve discharge (P < 0.01, r = 0.7021), but not with hemodynamic index (HR: P > 0.05, r = -0.03263; MAP: P > 0.05, r = -0.08993; RPP: P > 0.05, r = -0.03263). Some neurons (Neuron C) were negatively correlated with vagus nerve discharge, HR, MAP and RPP in the AMI + EA group (vagus nerve discharge: P < 0.05, r = -0.87749; HR: P < 0.01, r = -0.91902; MAP: P < 0.05, r = -0.85691; RPP: P < 0.01, r = -0.91902). Some neurons (Neurons C, D and E) were positively correlated with vagus nerve discharge, HR, MAP and RPP in the AMI + EA + Lesion group (vagus nerve discharge: P < 0.01, r = 0.8905, P < 0.01, r = 0.9725, P < 0.01, r = 0.9054; HR: P < 0.01, r = 0.9347, P < 0.01, r = 0.9089, P < 0.05, r = 0.8247; MAP: P < 0.05, r = 0.8474, P < 0.01, r = 0.9691, P < 0.01, r = 0.9027; RPP: P < 0.05, r = 0.8637, P < 0.01, r = 0.9407, P < 0.01, r = 0.9027). These findings show that the hippocampus-nucleus tractus solitarius-vagus nerve pathway is involved in the cardioprotective effect of EA at the heart meridian. Some interneurons in the nucleus tractus solitarius may play a particularly important role in the cardiomodulatory process.

Substituting one Paris for another? In vitro cytotoxic and in vivo antitumor activities of Paris forrestii, a substitute of Paris polyphylla var. yunnanensis.

ETHNOPHARMACOLOGICAL RELEVANCE: Chong-lou (Paris polyphylla var. yunnanensis or P. polyphylla var. chinensis) is traditionally used as an anticancer medicine in China. It is also the material basis of some Chinese patent anticancer medicines, such as Gan-Fu-Le capsules, Bo-Er-Ning capsules, Lou-Lian capsules, Ruan-Jian oral liquid, and Qi-Zhen capsules. P. forrestii, a substitute for Chong-lou, is planted at a large scale in the Yunnan Province of China. AIM OF THE STUDY: To clarify the active chemical constituents of P. forrestii and evaluate the in vitro and in vivo anticancer activities of the total saponins from P. forrestii. MATERIALS AND METHODS: The total saponins of P. forrestii were extracted and separated to yield pure compounds by chromatographic techniques, and the structures of the isolates were elucidated by spectroscopic methods. The cytotoxicity of the crude extracts, total saponins, and chemical constituents were evaluated using an MTS assay. In vivo antitumor activities of the total saponins from P. forrestii were measured using H22 tumor-bearing mice by intraperitoneal (ip) administration. RESULTS: Eight compounds, including polyphyllin D (1), formosanin C (2), dioscin (3), diosgenin-3-O-α-l-rhamnopyranosyl-(1→2)-ß-d-glucopyranoside (4), paris saponin H (5), pennogenin-3-O-α-l-rhamnopyranosyl-(1→2)-[α-l-rhamnopyranosyl-(1→4)]-ß-d-glucopyranoside (6), pariposide A (7), and crustecdysone (8), were isolated from the total saponins of P. forrestii. The total saponins and compounds 1-6 showed significant inhibitory activity against the growth of the HL-60, SMMC-7721, A-549, MCF-7, and SW480 cell lines. The total saponins from P. forrestii had a tumor-inhibitory effect in H22 tumor-bearing mice upon ip (2.25 mg/kg dose) administration, with an inhibition rate of 42.6% compared with cisplatin (ip, 2 mg/kg dose, 53.9% inhibition rate). CONCLUSION: The results support that P. forrestii could be a substitute for P. polyphylla var. yunnanensis as an anticancer medicine.

An analysis of healthy workplace accreditation and health promotion efforts based on employees' perspectives.

This study was conducted to analyze the effects of health promotion efforts in relation to a workplace accreditation program and differing workplace sizes. The research population for the study consisted of 966 employees working at a total of 84 different worksites located in Taipei, Taiwan. The survey instructions used were developed by the European Network for Workplace Health Promotion (WHP). The results indicate that accredited workplaces have better WHP quality than nonaccredited workplaces (p < .001) and commonly implement health promotion measures related to specific health issues. It is recommended that the government provide more health-related resources in workplaces, especially those of small and medium companies.

Employer and Promoter Perspectives on the Quality of Health Promotion Within the Healthy Workplace Accreditation.

OBJECTIVES: To explore the employers' and promoters' perspective of health promotion quality according to the healthy workplace accreditation. METHODS: We assessed the perspectives of 85 employers and 81 health promoters regarding the quality of health promotion at their workplaces. The method of measurement referenced the European Network for Workplace Health Promotion (ENWHP) quality criteria. RESULTS: In the large workplaces, the accredited corporation employers had a higher impression (P < 0.001) of all criteria. The small-medium accredited workplace employers had a slightly higher perspective than non-accredited ones. Nevertheless, there were no differences between the perspectives of health promoters from different sized workplaces with or without accreditation (P > 0.05). CONCLUSIONS: It seems that employers' perspectives of healthy workplace accreditation surpassed employers from non-accredited workplaces. Specifically, large accredited corporations could share their successful experiences to encourage a more involved workplace in small-medium workplaces.

[Effect of Electroacupuncture Stimulation of Heart Meridian on Autonomic Nervous Activities in Acute Myocardial Ischemia Rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) stimulation of the Heart Meridian on electrical activities of neck sympathetic and vagal nerves in acute myocardial ischemia (AMI) rats. METHODS: Thirty SD rats were randomly divided into 3 groups, sham operation (sham), model and EA(n=10 rats in each group). The left anterior descending branch (LADB) of the coronary artery was occluded to make an acute myocardial ischemia (AMI) model.For rats of the sham group, a surgical suture was simply threaded beneath the LADB without ligation. EA stimulation (2 Hz, 1 mA)was applied to bilateral "Shenmen" (HT 7), "Tongli" (HT 5) and the middle-point between HT 7 and HT 5 for 20 min. The electrical activities of the left cervical sympathetic and vagal nerves were recorded using a bipolar platinum wire electrodes and a BIOPAC MPl 50 system, and the electrocardiogram (ECG) of the standard limb lead Ⅱ was recorded simultaneously. The AMI severity was evaluated by using J-spot height of ECG. RESULTS: After AMI, the heart rate (HR), J-spot of ECG, and the discharge frequency of the cervical sympathetic nerve were significantly increased in the model group compared with the sham group (P<0.01), while the discharge frequency of vagal nerve was obviously decreased (P<0.01). Following EA stimulation, the increased levels of HR, J-spot height and discharge frequency of sympathetic nerve, and the decreased discharge frequency of vagus were significantly suppressed at time-points of 1, 3, 5 and 15 min after EA (P<0.01). In addition, the ratio of discharge frequencies of vagal/sympathetic nerves was notably down-regulated after AMI (P<0.01). After EA stimulation, the ratios of vagal/sympathetic discharge at the time-points of 1, 3, 5 and 15 min following EA were significantly increased (P<0.01). CONCLUSIONS: EA stimulation of the Heart Meridian may improve AMI by inhibiting sympathetic discharges and elevating vagal discharges in AMI rats, i.e., coordinating activities of the autonomic nerve systems.

Modified IDSA/ATS Minor Criteria for Severe Community-Acquired Pneumonia Best Predicted Mortality.

It is not clear whether the IDSA/ATS minor criteria for severe community-acquired pneumonia (CAP) could be simplified or even be modified to orchestrate improvements in predicting mortality.A retrospective cohort study of 1230 CAP patients was performed to simplify and to modify the scoring system by excluding 4 noncontributory or infrequent variables (leukopenia, hypothermia, hypotension, and thrombocytopenia) and by excluding these variables and then adding age ≥65 years, respectively. The simplification and modification were tested against a prospective 2-center validation cohort of 1409 adults with CAP.The increasing numbers of IDSA/ATS, simplified, and modified minor criteria present in the retrospective cohort were positively associated with the mortality, showing significant increased odds ratios for mortality of 2.711, 4.095, and 3.755, respectively. The validation cohort confirmed a similar pattern. The sensitivity, specificity, positive predictive value, and Youden index of modified minor criteria for mortality prediction were the best pattern in the retrospective cohort. High values of corresponding indices were confirmed in the validation cohort. The highest accuracy of the modified version for predicting mortality in the retrospective cohort was illustrated by the highest area under the receiver operating characteristic curve of 0.925 (descending order: modified, simplified, and IDSA/ATS minor criteria). The validation cohort confirmed a similar paradigm.The IDSA/ATS minor criteria could be simplified to 5 variables and then be modified to orchestrate improvements in predicting mortality in CAP patients. The modified version best predicted mortality. These were more suitable for clinic and emergency department.

Mortality among severe community-acquired pneumonia patients depends on combinations of 2007 IDSA/ATS minor criteria.

OBJECTIVES: The individual 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is not clear whether the combinations of predictive findings might imply diverse severities or different mortalities. METHODS: A prospective two centre cohort study was performed of 385 severe CAP patients fulfilling three or more IDSA/ATS minor criteria amongst 1430 patients. RESULTS: Hospital mortality rose sharply from 5.7%, 9.9%, and 16.5%, respectively, for patients with none of three predictive findings most strongly associated to mortality (PaO2/FiO2 ≤ 250mm Hg, confusion and uraemia), one of those, and two of those to 38.6% for patients with all those (p<0.001). The number of three predictive findings present had a significantly increased odds ratio for mortality of 2.796 (p<0.001), and had the degree of positive association with sequential organ failure assessment scores at 72hours, incurring significantly longer hospital stay and higher costs. CONCLUSIONS: Different combinations of 2007 IDSA/ATS minor criteria for severe CAP were associated to diverse severities and different mortalities. The combination of PaO2/FiO2 ≤ 250mm Hg, confusion and uraemia predicted more severity and higher mortality compared with others.

CUR-65 Score for Community-Acquired Pneumonia Predicted Mortality Better Than CURB-65 Score in Low-Mortality Rate Settings.

BACKGROUND: It is not clear whether low-blood pressure criterion could be removed from CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure and age ≥65 years) score to orchestrate an improvement in identifying patients with community-acquired pneumonia (CAP) in low-mortality rate settings. METHODS: A retrospective cohort study of 1,230 CAP patients was performed to simplify the CURB-65 scoring system by excluding low-blood pressure variable. The simplification was validated in a prospective 2-center cohort of 1,409 adults with CAP. RESULTS: The hospital mortalities were 1.3% and 3.8% in the retrospective and prospective cohorts, respectively. The mortality rates in the 2 cohorts increased directly with the increasing scores, showing significant increased odds ratios for mortality. The pattern of sensitivity, specificity, positive predictive value and Youden's index of a CUR-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min and age ≥65 years) score of ≥2 for prediction of mortality was better than that of a CURB-65 score of ≥3 in the retrospective cohort. Higher values of corresponding indices were confirmed in the validation cohort. The higher accuracy of CUR-65 score for predicting mortality was illustrated by the area under the receiver operating characteristic curve of 0.937, compared with 0.915 for CURB-65 score in the retrospective cohort (P = 0.0073). The validation cohort confirmed a similar paradigm (0.953 versus 0.907, P = 0.0002). CONCLUSIONS: CURB-65 score could be simplified by removing low blood pressure to orchestrate an improvement in predicting mortality in CAP patients who have a low risk of death. A CUR-65 score of ≥2 might be a more valuable cutoff value for severe CAP.

[Research progress on effects of traditional Chinese medicines on proliferation, apoptosis and differentiation of bone marrow mesenchymal stem cells].

Bone marrow mesenchymal stem cells (BMSCs) are a kind of pluripotent stem cells derived from bone marrows, which can not only support hematopoiesis, but also have capabilities of multidifferentiation, high-proliferation and self-renewing. They have become one of hotspots in stem cell studies. Studies on in vitro intervention with BMSCs with TCMs have made remarkable progress in recent years. According to the findings, some traditional Chinese medicines can promote proliferation of BMSCs, some can inhibit the apoptosis of BMSCs, while others can induce BMSCs to differentiate into multiple cell types, such as osteoblast. Furthermore, some studies also involved relevant action mechanisms. The authors summarized the advance in relevant studies by reference to relevant literatures of this field.

Associations of radiological features in Mycoplasma pneumoniae pneumonia.

INTRODUCTION: The associations of radiological features with clinical and laboratory findings in Mycoplasma pneumoniae infection are poorly understood. The purpose of this study was to assess the associations. MATERIAL AND METHODS: A retrospective cohort study of 1230 patients with community-acquired pneumonia was carried out between January 2005 and December 2009. The diagnosis of M. pneumoniae infection was made using the indirect microparticle agglutinin assay and enzyme-linked immunosorbent assay. RESULTS: Females were more susceptible to M. pneumoniae infection. Ground-glass opacification on radiographs was positively associated with M. pneumoniae-IgM titres (rank correlation coefficient (r s) = 0.141, p = 0.006). The left upper lobe was more susceptible to infection with M. pneumoniae compared with other pathogens. More increases in the risk of multilobar opacities were found among older or male patients with M. pneumoniae pneumonia (odds ratio, 1.065, 3.279; 95% confidence interval, 1.041-1.089, 1.812-5.934; p < 0.001, p < 0.001; respectively). Patients with M. pneumoniae pneumonia showing multilobar opacities or consolidation had a significantly longer hospital length of stay (r s = 0.111, r s = 0.275; p = 0.033, p < 0.001; respectively), incurring significantly higher costs (r s = 0.119, r s = 0.200; p = 0.022, p < 0.001; respectively). CONCLUSIONS: Our study highlighted female susceptibility to M. pneumoniae pneumonia and the association of ground-glass opacification with higher M. pneumoniae-IgM titres. The left upper lobe might be more susceptible to M. pneumoniae infection. Older or male patients with M. pneumoniae pneumonia were more likely to show multilobar opacities. Multilobar opacities and consolidation were positively associated with hospital length of stay and costs.

[Comparative study on effects of electroacupuncture stimulation of Shenmen (HT 7) and Taiyuan (LU 9) on P 300 of event-related potentials and brain electrical activity mapping in healthy young adults].

OBJECTIVE: To observe the effect difference of electroacupuncture (EA) stimulation of Shenmen (HT 7) and Taiyuan (LU 9) on P 300 of event-related potentials (ERPs) in volunteer subjects, so as to explore functional specificity of acupoints in processing cerebral information. METHODS: Sixty healthy volunteer college students were randomly and equally divided into Shenmen (HT 7) group and Taiyuan (LU 9) group (30 persons/group). EA (2 Hz, 1 mA) was applied to bilateral Shenmen (HT 7) and Taiyuan (LU 9) for 15 min. The ERPs were acquired by averaging EEG activity following Oddba II auditory tone-double stimuli and brain electrical activity mapping (BEAM) acquired by means of Scan 4.5 collection and analysis system. Data were calculated and analyzed with SPSS 17.0 for Windows. After testing, the subjects were inquired about the perception for acupuncture stimulation and other sensations or psychological activities. RESULTS: Following EA stimulation of both HT 7 and LU 9, the amplitude of P 300 in the ERPs were significantly decreased in comparison with pre-EA stimulation in the same one group (P < 0.01, P < 0.05). No significant changes were found in the latencies of P 300 after EA stimulation of both HT 7 and LU 9 (P > 0.05). But, EA of HT 7 had a slightly stronger effect in shortening P 300 latency. With regard to the potential intensity distribution of BEAM, there were some differences between HT 7 and LU 9 groups. The high potential responses for HT 7 were found mainly in the occipital lobe, and in the left parietal lobe and the right temporal lobe, whereas those for LU 9 were found to mainly disperse in the left occipital lobe and the parietal lobe. CONCLUSION: EA stimulation of HT 7 and LU 9 has a slight difference on lowering P 300 amplitude of ERPs, and may result in different distribution of the high potential responses in different lobes of the cerebral cortex in healthy subjects. The functional specificity of EA stimulation of different acupoints needs further study.