Medical students' knowledge and attitude toward brain death and the influence of medical education: a cross-sectional study.

BACKGROUND: The medical students' knowledge and attitude toward brain death has not been investigated in China. The aims of this study were to assess the knowledge and attitude toward brain death among medical students in China and assess the influence of medical education on the knowledge and attitude. METHODS: An online questionnaire consisting of 17 questions was developed and completed by undergraduates majoring in clinical medicine in China Medical University. The students' demographic data, knowledge and attitude toward brain death were collected and analyzed. RESULTS: A total of 1075 medical students participated in the survey, and 1051 of them completed the valid questionnaire. The exploratory factor analysis grouped the 17 items into four dimensions, which explained 63.5% of the total variance. These dimensions were named as knowledge (5 items), attitude (5 items), concern (3 items) and education needs (4 items) respectively. The global Cronbach α of the questionnaire was 0.845 and the Cronbach α of the four dimensions ranged from 0.756 to 0.866. The mean dimension scores of knowledge, attitude, concern and education needs was 3.67 ± 0.89, 3.67 ± 0.87, 3.10 ± 1.03 and 4.12 ± 0.72 respectively. The clinical students had a better knowledge than the preclinical students (P < 0.001). The clinical students had a more favorable attitude in stopping the treatment for a brain-dead family member and using the organs and/or tissues of brain-dead patients for transplantation (P < 0.001). The clinical students showed more concerns than the preclinical students (P < 0.001). There was no significant difference in the education needs between the clinical and pre-clinical students. CONCLUSIONS: Most medical students in China had insufficient knowledge about brain death. Although their knowledge of brain death increased with their university degree, their attitude toward organ donation after brain death did not evolve accordingly. Their concerns about brain death increased with seniority. Most students had great education needs about brain death.

Effect of virtual reality training to enhance laparoscopic assistance skills.

BACKGROUND: While laparoscopic assistance is often entrusted to less experienced individuals, such as residents, medical students, and operating room nurses, it is important to note that they typically receive little to no formal laparoscopic training. This deficiency can lead to poor visibility during minimally invasive surgery, thus increasing the risk of errors. Moreover, operating room nurses and medical students are currently not included as key users in structured laparoscopic training programs. OBJECTIVES: The aim of this study is to evaluate the laparoscopic skills of OR nurses, clinical medical postgraduate students, and residents before and after undergoing virtual reality training. Additionally, it aimed to compare the differences in the laparoscopic skills among different groups (OR nurses/Students/Residents) both before and after virtual reality training. METHODS: Operating room nurses, clinical medical postgraduate students and residents from a tertiary Grade A hospital in China in March 2022 were selected as participants. All participants were required to complete a laparoscopic simulation training course in 6 consecutive weeks. One task from each of the four training modules was selected as an evaluation indicator. A before-and-after self-control study was used to compare the basic laparoscopic skills of participants, and laparoscopic skill competency was compared between the groups of operating room nurses, clinical medical postgraduate students, and residents. RESULTS: Twenty-seven operating room nurses, 31 clinical medical postgraduate students, and 16 residents were included. The training course scores for the navigation training module, task training module, coordination training module, and surgical skills training module between different groups (operating room nurses/clinical medical postgraduate/residents) before laparoscopic simulation training was statistically significant (p < 0.05). After laparoscopic simulation training, there was no statistically significant difference in the training course scores between the different groups. The surgical level scores before and after the training course were compared between the operating room nurses, clinical medical postgraduate students, and residents and showed significant increases (p < 0.05). CONCLUSION: Our findings show a significant improvement in laparoscopic skills following virtual surgery simulation training across all participant groups. The integration of virtual surgery simulation technology in surgical training holds promise for bridging the gap in laparoscopic skill development among health care professionals.

An online delirium detection tool: Cross-cultural adaptation of a Chinese version of the Family Confusion Assessment Method.

BACKGROUND: Intensive care unit (ICU) delirium is a common complication in older critically ill patients that has a significant impact. The Family Confusion Assessment Method (FAM-CAM) is a vital tool for assisting family members in identifying delirium; however, no study has yet been reported on the Chinese version of the scale. OBJECTIVES: The objective of this study was to translate the FAM-CAM into a Chinese version and to verify its effectiveness for delirium detection in an online patient visit setting. METHODS: This was a cross-sectional study. The FAM-CAM was translated to Chinese according to the International Society for Pharmacoeconomics and Outcomes Research guidelines. Patients and family members were recruited to participate in delirium assessments in three ICUs of one hospital. Family members then used the Chinese version of the FAM-CAM to assess for delirium via online visitation, and ICU nurses assessed patients for delirium using the Intensive Care Delirium Screening Checklist (ICDSC). Results were then compared between family members' and nurses' assessments. RESULTS: Overall, 190 critically ill patients and 190 family members were included, of whom 117 (61.6%) were assessed for delirium using the Intensive Care Delirium Screening Checklist. The Cohen's kappa coefficient between the Intensive Care Delirium Screening Checklist and FAM-CAM was 0.759 (P < 0.01). The sensitivity of the Chinese version of the FAM-CAM was 0.880, specificity was 0.890, positive predictive value was 0.928, negative predictive value was 0.823, and area under the receiver operating characteristic curve was 0.881 (95% confidence interval: 0.872-0.935, P < 0.01). CONCLUSION: The Chinese version of the FAM-CAM was shown to effectively help families detect delirium and was suggested as a crucial tool for assisting ICU nurses in the early identification of delirium. This tool may effectively be used to assess delirium during online visits.

Mucinous cystadenocarcinoma of the ovary in a 14-year-old girl: a case report and literature review.

BACKGROUND: Ovarian epithelial tumors are common in adults, and their peak incidence of onset is over 40 years of age. In children, most ovarian tumors are germ cell-derived, whereas epithelial tumors are rare and mostly benign. CASE PRESENTATION: This report describes a case of a 14-year-old Chinese girl with ovarian mucinous cystadenocarcinoma. She was admitted with a small amount of bloody vaginal discharge during the past month. Magnetic resonance imaging of the abdomen and pelvis showed a large solid cystic mass lesion in the left ovary. Tumor marker levels were within normal limits ( CA-125: 22.3 U/mL, HE4: 28.5 pmol/L, HCG: < 1.20 mIU/ml, AFP: 3.3 ng/ml, CEA: 2.2 ng/ml, CA19-9: < 2.0 U/mL). Laparoscopic exploration revealed a large left ovarian tumor. The patient underwent left salpingo-oophorectomy, and showed no significant issues during follow-up, as well as no evidence of recurrence or metastasis. CONCLUSIONS: We report the first pediatric case of ovarian mucinous cystadenocarcinoma in China. Given the scarcity of reports addressing the clinical management of this condition, the present study provides a useful contribution to its further understanding in light of developing future treatment strategies.

Anesthetic Management of Patients With Kartagener Syndrome: A Systematic Review of 99 Cases.

KARTAGENER SYNDROME (KS) is characterized by the triad of chronic sinusitis, bronchiectasis, and situs inversus. The mirrored anatomy and respiratory infections in patients with KS patients pose great challenges for anesthetic management. The aim of this review is to summarize published cases with the hope of helping anesthesiologists perform anesthesia in patients with KS more safely. A comprehensive literature search for all cases of anesthetic management of KS patients was performed in Pubmed, EMBASE, CNKI, and Wanfang Database. The extracted data included age, sex, type of surgery, preoperative treatment, type of anesthesia, anesthetic agents, airway management, central venous catheterization, transesophageal echocardiogram, reversal of neuromuscular blockade, adverse events during the surgery, and postoperative complications. The study authors included 82 single-case reports, 3 case series, and 1 case cohort, with a total number of 99 patients. The most common surgical procedures were thoracic surgery (51.5%), which was followed by ear, nose, and throat surgery (16.5%), and general surgery (14.5%). The preoperative treatment of the patients was reported in only 20 patients, and included antibiotics, bronchodilators, steroids, chest physiotherapy, and postural drainage. General anesthesia was performed for 85.4% of the surgeries, and regional anesthesia was performed in 14.6% of the cases. For nonthoracic surgery, an endotracheal tube was the most commonly used airway device. For thoracic surgery, a double-lumen tube was the most commonly used airway device. The intraoperative process was uneventful in most patients, and most patients recovered smoothly in the postoperative course.

Multi-user upper limb rehabilitation training system integrating social interaction.

COVID-19 causes persistent symptoms such as weakness and myasthenia in most patients. Due to the cross-infection of COVID-19, the traditional face-to-face rehabilitation services are risky for the elderly. To ensure that the elderly in urgent need of rehabilitation services receive training while minimizing the disturbance of the COVID-19 pandemic on their social activities. We have improved the existing virtual upper limb training system, and added a social factor to the system. Seniors with upper limb rehabilitation needs can use the system to compete or collaborate with others for training. In addition, a set of natural and scientific exclusive gestures have been designed under the direction of following the doctor's advice. The experiment is conducted jointly with the chief physicians of the geriatrics department in the authoritative class-A hospitals of Class III. Our experiment, which lasted for two months, showed that the virtual training system with social factors added had the best rehabilitation effect and enhanced the initiative of patients. The system has value for popularization during the COVID-19 epidemic.

Application of network teaching in nursing undergraduate education during the coronavirus disease 2019 epidemic.

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is currently raging all over the world. COVID-19 can be transmitted among humans. To control the spread of the epidemic and meet the learning needs of students, Chinese universities have used a variety of multimedia forms to conduct online teaching. However, the influence of different teaching methods on the learning effects of nursing students has not been conclusive, and few studies have directly compared the differences in the effects of different teaching methods. Therefore, it is necessary to evaluate the impact of different teaching methods on students' learning effects. METHODS: A total of 119 participants from the graduating class of 2022 performed 4 validated classes (fundamental nursing, medical nursing, surgical nursing, and paediatric nursing) through network teaching. A total of 126 participants from the graduating class of 2021 used the traditional teaching method and were enrolled as a control group. All participants completed a questionnaire, which was designed by the school for teaching evaluation, and took a test after the courses. RESULTS: A total of 245 nursing undergraduates were ultimately enrolled. The analysis of the academic performance and the student evaluations from the four courses showed no significant difference between the network teaching group and the traditional teaching group for nursing undergraduates (all P > 0.05). CONCLUSION: Through the convenience of network teaching, teachers and students can choose the time and place of both their teaching and learning independently. Moreover, such use effectively prevents the spread of the epidemic. After the epidemic concludes, the continued use of the network teaching method can help improve teaching efficiency by being combined with the traditional teaching method.

Enhanced remediation of Cr(VI)-contaminated groundwater by coupling electrokinetics with ZVI/Fe3O4/AC-based permeable reactive barrier.

Although widely used in permeation reaction barrier (PRB) for strengthening the removal of various heavy metals, zero-valent iron (ZVI) is limited by various inherent drawbacks, such as easy passivation and poor electron transfer. As a solution, a synergistic system with PRB and electrokinetics (PRB-EK) was established and applied for the efficient removal of Cr(VI)-contaminated groundwater. As the filling material of PRB, ZVI/Fe3O4/activated carbon (ZVI/Fe3O4/AC) composites were synthesized by ball milling and thermal treatment. A series of continuous flow column experiments and batch tests was conducted to evaluate the removal efficiency of Cr(VI). Results showed that the removal efficiency of Cr(VI) remained above 93% even when the bed volume (BV) reached 2000 under the operational parameters (iron/AC mass ratio, 2:1; current, 5 mA). The mechanism of Cr(VI) removal by the PRB-EK system was revealed through field emission scanning electron microscopy images, X-ray diffraction, X-ray photoelectron spectroscopy, Fe2+ concentration, and redox potential (Eh) values. The key in Cr(VI) reduction was the Fe2+/Fe3+ cycle driven by the surface microelectrolysis of the composites. The application of an externally supplied weak direct current maintained the redox process by enhancing the electron transfer capability of the system, thereby prolonging the column lifetime. Cr(VI) chemical speciation was determined through sequential extraction, verifying the stability and safety of the system. These findings provide a scientific basis for PRB design and the in-situ remediation of Cr(VI)-contaminated groundwater.

Loss of androgen receptor promotes HCC invasion and metastasis via activating circ-LNPEP/miR-532-3p/RAB9A signal under hypoxia.

Development of novel targeted therapies remains the priority in hepatocellular carcinoma (HCC) treatments. Early reports have demonstrated that androgen receptor (AR) plays a suppressive role in HCC progression. However, the underlying mechanisms by which AR attenuates HCC development are still elusive, especially under hypoxic conditions. Herein, we demonstrated that AR/circ-LNPEP/miR-532-3p/RAB9A signaling axis was tightly involved in hypoxia-induced cell invasion of HCC cells. AR worked as a transcription factor to reduce circ-LNPEP expression level, which released its sponge potential of miR-532-3p, leading to the downregulation of RAB9A and inhibiting cell invasion of HCC cells. In vitro and in vivo animal model also confirmed that overexpression of circ-LNPEP could reverse the suppressive effect of AR on HCC cell invasion or tumor metastasis. Overall, our study supplements a critical mechanism by which AR suppresses HCC invasion/metastasis under hypoxic conditions, providing compelling rationale to develop novel therapy for better treatments of HCC.

Knowledge of and attitude toward xenotransplantation among medical students in China: A cross-sectional study.

BACKGROUND: There are great challenges in the psychosocial aspects of xenotransplantation. The aim of this study was to investigate the knowledge of and attitude toward xenotransplantation among medical students in China. METHODS: A questionnaire consisting of 12 questions was distributed to 1000 first-to-fifth grade medical students, with 200 students in each grade. The questionnaire was self-administered and completed anonymously with no information beforehand. RESULTS: The response rate of the questionnaire was 91.5%. Most students had a good knowledge about xenotransplantation. If the results of xenotransplantation were similar with human donation, the acceptance was 63.9% when both organs were available, 70.3% to shorten the waiting time, and 86.4% to save one's life. As for the risks of xenotransplantation, 46.2%, 46.1%, and 36.9% of the respondents were worried about the risk of disease transmission, immunosuppressants, and other unknown risks, respectively. With regard to the psychosocial impacts, 38.4%, 31.9%, and 52.3% were worried about changing one's nature as a human being, changing one's personality, and discrimination by others, respectively. CONCLUSION: Most medical students in China had a favorable attitude toward xenotransplantation. Students in the clinical years had a better knowledge of and more favorable attitude toward xenotransplantation. Their concern about the risks of xenotransplantation resolved slightly with seniority, but their concern about psychosocial impacts did not resolve with seniority.

Prediction of Double-Lumen Tube Size By Ultrasonography for Asian Women: A Prospective Observational Study.

OBJECTIVE: To assess the agreement of the diameter of the cricoid cartilage by computed tomography and ultrasonography and to compare the accuracy of the left double-lumen tubes (DLTs) and right DLTs predicted by ultrasonography for Asian women. DESIGN: Prospective observational study. SETTING: Academic, tertiary care hospital. PARTICIPANTS: Fifty female patients intubated with a left DLT and 50 female patients intubated with a right DLT. INTERVENTIONS: No intervention. MEASUREMENTS AND MAIN RESULTS: A radiologist measured the transverse cricoid diameter by computed tomography (CT), and an independent echographer measured the transverse cricoid diameter using ultrasonography. The size of the DLT was selected based on the cricoid diameter by ultrasonography. The agreement of the transverse cricoid diameter was assessed by computed tomography and ultrasonography. The accuracy of the DLT, the tracheal segment, and the bronchial segment were compared between the left intubation group and right intubation group. There was a good agreement between the transverse cricoid diameter measured by ultrasonography and CT (r = 0.946, p < 0.001). The overall accuracy of the DLTs was similar between the groups (86.0% v 92.0%, p = 0.318). There were no significant differences in the accuracy of the tracheal segment (96.0% v 94.0%; p = 1.000) and the bronchial segment (90.0% v 98.0%, p = 0.056). CONCLUSIONS: The transverse diameter of the cricoid cartilage in most Asian women can be accurately measured by ultrasonography. The size of the DLT for Asian women can be predicted by ultrasonography measurement of the cricoid diameter.

Berberine-mediated up-regulation of surfactant protein D facilitates cartilage repair by modulating immune responses via the inhibition of TLR4/NF-ĸB signaling.

The innate immune system drives inflammatory joint damage in osteoarthritis (OA) and regulates cartilage repair. Berberine chloride (BBR) is an isoquinoline alkaloid that shows immunomodulatory activity in a variety of cell lines. However, the immunomodulatory mechanisms of BBR in chondrocytes during OA are largely unknown. Herein, we assessed the ability of BBR to mediate chondroprotection through its effects on innate immunity. We found that BBR up-regulated the expression of surfactant protein D (SP-D) in OA cartilage, a key regulator of inflammation and innate immunity both in the airways and extrapulmonary tissues, including joint cartilage. To further explore these findings, we used recombinant adeno-associated virus (rAAV)-mediated knockdown of SP-D. Silencing was assessed in rat model of surgically-induced OA in the presence or absence of BBR treatment, 10 weeks post-surgery. We observed a clear improvement in histological scores of BBR-treated animals compared to those treated with BBR and the rAAV-SP-D vector. In addition, animals co-treated with BBR + recombinant human SP-D (rhSP-D) exhibited significantly lower histological scores than those treated with BBR alone. BBR treatment led to significantly reduced immune cell infiltration mediated through TLR4, F4/80, CD68 and CD34, whilst SP-D silencing reversed this improvement. In contrast, rhSP-D treatment enhanced the protective phenotype. We further explored how BBR influences SP-D and other OA-associated genes in vitro. We observed an up-regulation of SP-D and a marked decline in TRAF6, TLR4, MD-2 and MyD88 expression, as well as NF-κB p65 and IκBα phosphorylation in chondrocytes treated with sodium nitroprusside. siRNAs specific for SP-D were able to partially reverse this phenotype, whilst both rhSP-D and the TLR4 inhibitor TAK-242 enhanced the effects. Together, these results are consistent with a model wherein SP-D has therapeutic potential for OA treatment. Concomitantly, BBR modulates immune responses and decreases cartilage degradation. These findings suggest that BBR achieves this function through releasing SP-D from MD2/SP-D complexes and through the inhibition of TLR4/NF-κB signaling.

Airway Rupture Caused by Double-Lumen Tubes: A Review of 187 Cases.

The double-lumen tubes (DLTs) are the most widely used devices to provide perioperative lung isolation. Airway rupture is a rare but life-threatening complication of DLTs. The primary aim of this review was to collect all cases reported in the literature about airway rupture caused by DLTs and to describe the reported possible contributors, diagnosis, treatment, and outcomes of this complication. Another aim of this review was to assess the possible factors associated with mortality after airway rupture by DLTs. A comprehensive literature search for all cases of airway rupture caused by DLTs was performed in the PubMed, EMBASE, Ovid, Wanfang Database, and CNKI. The extracted data included age, sex, height, weight, type of operation, type and size of DLT, site of airway rupture, possible contributors, clinical presentation, diagnosis timing, treatment, and outcome. We included 105 single case reports and 22 case series with a total number of 187 patients. Most of the ruptures were in the trachea (n = 98, 52.4%) and left main bronchus (n = 70, 37.4%). The common possible contributors include use of a stylet, cuff overdistention, multiple attempts to adjust the position of a DLT, difficult intubation, and use of an oversized DLT. Most of the airway ruptures were diagnosed intraoperatively (n = 138, 82.7%). Pneumomediastinum, air leakage, hypoxemia, and subcutaneous emphysema were the common clinical manifestations. Most patients were treated with surgical repair (n = 147, 78.6%). The mortality of the patients with airway rupture by DLTs was 8.8%. Age, sex, site of rupture, diagnosis timing, and method of treatment were not found to be associated with mortality.

The Incidence of Tracheal Bronchus in Thoracic Surgery Patients and Its Implication for Lung Isolation: A Retrospective Cohort Study.

OBJECTIVE: To investigate the incidence of tracheal bronchus (TB) and explore its implication for lung isolation. DESIGN: Retrospective cohort study. SETTING: Academic, tertiary care hospital. PARTICIPANTS: The study comprised 7,102 thoracic patients with- one lung ventilation. INTERVENTIONS: No intervention. MEASUREMENTS AND MAIN RESULTS: Two independent anesthesiologists reviewed the computed tomography images to identify the presence of a TB, and their results were confirmed by a radiologist. The clinical data of patients with a TB were obtained from the electronic medical record. Data regarding the device used to provide lung isolation, preoperative oxygen saturation (SpO2), and intraoperative SpO2 during one- lung ventilation were obtained from the electronic anesthesia record. The incidence of TB was 1.08% (77 of 7,102). The TB arose from the right side of the trachea in all 77 patients, including 70 type Ⅲ TBs and 7 type Ⅱ TBs. Left- and right-sided double-lumen tubes (DLTs) were used in 54 and 23 patients, respectively. For patients with a left-sided DLT, the median SpO2 and incidence of hypoxemia (SpO2 <90%) were 97% and 6 of 54 (11.1%), respectively. For patients with a right DLT, the median SpO2 and incidence of hypoxemia were 95% and 7 of 20 (35.0%), respectively. There were significant differences in the mean SpO2 and the incidence of hypoxemia between patients intubated with left- and right-sided DLTs (p = 0.014 and p = 0.016, respectively). CONCLUSIONS: Preoperative diagnosis of TB is important when lung isolation is needed. The left-sided DLT can be used for most patients with a TB.

The development of the cricoid cartilage and its implications for the use of endotracheal tubes in the pediatric population.

BACKGROUND: The rigid cricoid cartilage is functionally the narrowest portion of the larynx. There is some controversy over the shape of the pediatric cricoid cartilage in the transverse plane. It is important to understand the development of the cricoid cartilage so that endo-traceheal tubes can be used more safely. AIM: To determine changes in the internal diameter and shape of the cricoid cartilage during development and explore the implications of those changes for the selection of ETT type and size for children. METHODS: The cervical computed tomography scans were reviewed in patients aged 1-20 years. After performing the multiplanar reconstruction and correcting the slant, the transverse and anteroposterior internal diameters of the inlet and outlet of the cricoid cartilage were measured, respectively. The angle between the arch and the lamina of the cricoid cartilage in the middle sagittal plane was measured. The ratios of transverse to anteroposterior diameter for the inlet and outlet of the cricoid cartilage were calculated, respectively. RESULTS: In females, the internal diameters of the cricoid cartilage increased linearly with age. In males, the internal diameters of the cricoid cartilage exhibited a growth spurt during adolescence. The transverse diameter of the inlet was the smallest diameter of the cricoid cartilage, and the predicting formula of the transverse diameter of the inlet for children aged 1-12 was 0.4 × age (year) + 5.1, R2  = .758. The angle between the arch and lamina of the cricoid cartilage and the ratios of transverse to anteroposterior diameter correlated weakly with age. CONCLUSION: The transverse inner diameter of the inlet is the smallest diameter of the cricoid cartilage. The "funnel shape" of the cricoid cartilage remains unchanged during development. The outer diameter should be considered when selecting an endotracheal tube.

Value of ambroxol in the treatment of asthmatic bronchitis.

OBJECTIVE: To investigate the clinical effect of ambroxol in the treatment of asthmatic bronchitis. METHODS: One hundred and twenty patients with asthmatic bronchitis who were admitted to our hospital from June 2017 to August 2018 were selected as the research subjects and divided into a control group and an observation group according to random number table method, 60 in each group. The control group was treated with conventional treatment, while the observation group was treated with ambroxol in addition to conventional treatment. The therapeutic effect, disappearance time of symptoms and signs and the recovery of pulmonary function were compared between the two groups. RESULTS: The total effective rate of the observation group was 96.7%, and that of the control group was 73.3%. The control effect of the observation group was significantly better than that of the control group, showing a significant difference (P<0.05). The disappearance time of symptoms of the observation group was shorter than that of the control group, and the recovery of pulmonary function was better; the differences were statistically significant (P<0.05). CONCLUSION: For asthmatic bronchitis patients, addition of ambroxol to conventional treatment can improve the therapeutic effect, shorten the disappearance time of clinical signs and symptoms, and promote the recovery of patients, which is worth clinical application.

Ligustilide attenuates nitric oxide-induced apoptosis in rat chondrocytes and cartilage degradation via inhibiting JNK and p38 MAPK pathways.

Ligustilide (LIG) is the main lipophilic component of the Umbelliferae family of pharmaceutical plants, including Radix angelicae sinensis and Ligusticum chuanxiong. LIG shows various pharmacological properties associated with anti-inflammation and anti-apoptosis in several kinds of cell lines. However, the therapeutic effects of LIG on chondrocyte apoptosis remain unknown. In this study, we investigated whether LIG had an anti-apoptotic activity in sodium nitroprusside (SNP)-stimulated chondrocyte apoptosis and could delay cartilage degeneration in a surgically induced rat OA model, and elucidated the potential mechanisms. In vitro studies revealed that LIG significantly suppressed chondrocyte apoptosis and cytoskeletal remodelling, which maintained the nuclear morphology and increased the mitochondrial membrane potential. In terms of SNP, LIG treatment considerably reduced the expression levels of cleaved caspase-3, Bax and inducible nitric oxide synthase and increased the expression level of Bcl-2 in a dose-dependent manner. The LIG-treated groups presented a significantly suppressed expression of activating transcription factor 2 and phosphorylation of Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (MAPK). The inhibitory effect of LIG was enhanced by the p38 MAPK inhibitor SB203580 or the JNK inhibitor SP600125 and offset by the agonist anisomycin. In vivo studies demonstrated that LIG attenuated osteoarthritic cartilage destruction by inhibiting the cartilage chondrocyte apoptosis and suppressing the phosphorylation levels of activating transcription factor 2, JNK and p38 MAPK. This result was confirmed by histological analyses, micro-CT, TUNEL assay and immunohistochemical analyses. Collectively, our studies indicated that LIG protected chondrocytes against SNP-induced apoptosis and delayed articular cartilage degeneration by suppressing JNK and p38 MAPK pathways.

Surfactant protein D attenuates nitric oxide-stimulated apoptosis in rat chondrocyte by suppressing p38 MAPK signaling.

Innate immune molecule surfactant protein D (SP-D), a member of the C-type lectin protein family, plays an indispensable role in host defense and the regulation of inflammation in the lung and other tissues. Osteoarthritis (OA) is a degenerative disease of cartilage, with inflammation that causes pathologic changes and tissue damage. However, it is unknown whether there exist SP-D expression and its potential role in the pathogenesis of OA. In this study, we examined SP-D expression and explored its biological function in a sodium nitroprusside (SNP)-stimulated rat chondrocytes and surgically-induced rat OA model. We found SP-D expression in both human and rat articular chondrocytes, with higher level in normal chondrocytes compared to in OA chondrocytes. Furthermore, In vivo study demonstrated that recombinant human SP-D (rhSP-D) ameliorated cartilage degeneration in surgically-induced rat OA model. In vitro cell culture study showed that rhSP-D markedly inhibited the expression of caspase-3 as an apoptosis biomarker, and decreased phosphorylation of p38 mitogen-activated protein kinase (MAPK), which resulted in maintaining normal nuclear morphology and increasing mitochondrial membrane potential in SNP-stimulated rat chondrocytes. Collectively, these findings indicate that SP-D expresses in articular chondrocytes and suppresses SNP-stimulated chondrocyte apoptosis and ameliorates cartilage degeneration via suppressing p38 MAPK activity.

Sustained release effects of berberine-loaded chitosan microspheres on in vitro chondrocyte culture.

The low bioavailability and short biological half-life of berberine chloride (BBR) negatively affect the protective role of this compound against osteoarthritis (OA). The present study was performed to evaluate the effectiveness of sustained BBR release system. Novel BBR-loaded chitosan microspheres (BBR-loaded CMs) were successfully synthesized using an ionic cross-linking method for sustained release. The basic characteristics of the prepared microspheres were subsequently evaluated by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD) techniques, encapsulation efficiency (EE), and in vitro release experiments. BBR-loaded CMs displayed spherical forms to encapsulate a considerable quantity of BBR (100.8 ± 2.7 mg/g); these microspheres also exhibited an ideal releasing profile. The FT-IR spectra and XRD results revealed that BBR-loaded CMs were successfully synthesized via electrostatic interaction. In vitro experiments further showed that BBR-loaded CMs significantly inhibited sodium nitroprusside (SNP)-stimulated chondrocyte apoptosis as well as cytoskeletal remodeling, and led to increasing mitochondrial membrane potential and maintaining the nuclear morphology. BBR-loaded CMs exerted markedly higher anti-apoptotic activity in the treatment of OA, and markedly inhibited the protein expression levels of caspase-3, a disintegrin, and metalloproteinase with thrombospondin motifs (ADAMTS)-5 and matrix metalloproteinase (MMP)-13 induced by SNP in rat articular chondrocytes, compared with free BBR at equivalent concentration. Therefore, novel BBR-loaded CMs may offer potential for application in the treatment of OA.

SOX5 promotes epithelial-mesenchymal transition in osteosarcoma via regulation of Snail.

PURPOSE: SOX5 plays important roles in various kinds of cancers. However, the expression and roles of SOX5 in osteosarcoma (OS) have not been investigated well. In the present study we aimed to investigate the mechanism of SOX5 in OS. METHODS: OS and adjacent non-cancerous specimens were obtained from patients with OS. PCR was applied to detect SOX5 mRNA. Then human OS cell lines (U2OS, SoSP-M, SoSP-9607, and MG-63) and one immortalized normal osteoblast hFOB1.19 were investigated. SOX5 knocking with shRNA in U2OS and SOX5 upregulation with recombinant plasmid in MG-63 were applied. Real-time cell monitoring system and invasion assay were used, and Western blot assay was performed to detect the protein level of E-cadherin, N-cadherin, Vimentin and Snail, where Glyceraldehyde3- phosphate dehydrogenase (GAPDH) was presented as control. P<0.05 was considered as statistically significant. RESULTS: Significant upregulation of SOX5 in OS tissues and cell lines was identified. The gain- and loss-of-function studies suggested that OS cell migration and invasion were promoted significantly by SOX5. Additionally, SOX5 promoted epithelial-mesenchymal transition (EMT) by regulation of Snail. CONCLUSION: SOX5 is a novel regulator of EMT in OS, and is a potential target for OS.