The influence of coronavirus disease 2019 on emergency department visits in Nanjing, China: A multicentre cross-sectional study.

INTRODUCTION: Influenza has been linked to the crowding in emergency departments (ED) across the world. The impact of the Coronavirus Disease 2019 (COVID-19) pandemic on China EDs has been quite different from those during past influenza outbreaks. Our objective was to determine if COVID-19 changed ED visit disease severity during the pandemic. METHODS: This was a retrospective cross sectional study conducted in Nanjing, China. We captured ED visit data from 28 hospitals. We then compared visit numbers from October 2019 to February 2020 for a month-to-month analysis and every February from 2017 to 2020 for a year-to-year analysis. Inter-group chi-square test and time series trend tests were performed to compare visit numbers. The primary outcome was the proportion of severe disease visits in the EDs. RESULTS: Through February 29 th 2020, there were 93 laboratory-confirmed COVID-19 patients in Nanjing, of which 40 cases (43.01%) were first seen in the ED. The total number of ED visits in Nanjing in February 2020, were dramatically decreased (n = 99,949) in compared to January 2020 (n = 313,125) and February 2019 (n = 262,503). Except for poisoning, the severe diseases in EDs all decreased in absolute number, but increased in proportion both in year-to-year and month-to-month analyses. This increase in proportional ED disease severity was greater in higher-level referral hospitals when compared year by year. CONCLUSION: The COVID-19 outbreak has been associated with decreases in ED visits in Nanjing, China, but increases in the proportion of severe ED visits.

Effects of Shengmai injection add-on therapy to chemotherapy in patients with non-small cell lung cancer: a meta-analysis.

PURPOSE: Shengmai injection (SMI) has shown promising outcomes in the management of non-small cell lung cancer (NSCLC). This meta-analysis aimed to investigate the add-on effects of SMI to chemotherapy in NSCLC patients. METHODS: A comprehensive literature search was performed in the Cochrane Library, PubMed, Embase, CNKI, VIP, and Wanfang up to December 2017. Only randomized controlled trials (RCTs) evaluating SMI in combination with chemotherapy versus chemotherapy alone in NSCLC patients were eligible. The outcome measures were quality of life, chemotherapy-induced grade 3/4 myelosuppression or gastrointestinal reactions, and objective tumor response (equals complete response plus partial response). Pooled risk ratio (RR) with 95% confidence interval (CI) was used to evaluate dichotomous and continuous outcome, respectively. RESULTS: A total of 15 RCTs were included and analyzed. Meta-analysis showed that SMI combined with chemotherapy was associated with a significant improvement in Karnofsky Performance Status (RR 2.36; 95% CI 1.50-3.96) compared with the chemotherapy alone. Moreover, adjunctive treatment with SMI significantly reduced grade 3/4 myelosuppression (RR 0.61; 95% CI 0.46-0.81) and gastrointestinal reactions (RR 0.64; 95% CI 0.46-0.90). However, there was no significant difference in objective tumor response (RR 1.17; 95% CI 0.99-1.37) between two groups. CONCLUSIONS: SMI add-on therapy appeared to be more effective in improving quality of life and reducing chemotherapy-induced adverse effects. However, more well-designed RCTs are warranted to confirm the findings of this meta-analysis because of the suboptimal methodological quality of the included trials.

Tanshinone IIA attenuates heart failure via inhibiting oxidative stress in myocardial infarction rats.

The purpose of the present study was to evaluate whether tanshinone IIA (TIIA) could treat cardiac dysfunction and fibrosis in heart failure (HF) by inhibiting oxidative stress. An HF model was induced by ligation of the left anterior descending artery to cause ischemia myocardial infarction (MI) in Sprague­Dawley rats. Cardiac fibrosis was evaluated using Masson's staining, and the levels of collagen I, collagen III, TGF­ß, α­smooth muscle actin (α­SMA), matrix metalloproteinase (MMP) 2 and MMP9 were determined using PCR or western blotting. TIIA treatment reversed the decreases of left ventricular (LV) ejection fraction, fractional shortening (FS), LV systolic pressure and the maximum of the first differentiation of LV pressure (LV ± dp/dtmax), the increases of LV volume in systole, LV volume in diastole, LV end­systolic diameter and LV end­diastolic diameter in MI rats. TIIA administration also reversed the increases of expression levels of collagen I, collagen III, TGF­ß, α­SMA, MMP2 and MMP9 in the heart of MI rats and in angiotensin (Ang) II­treated cardiac fibroblasts (CFs). TIIA reversed the decreases of superoxide dismutase activity and malondialdehyde and the increases of superoxide anions and NADPH oxidase (Nox) activity in both MI rats and Ang II­treated CFs. Nox4 overexpression inhibited the effects of TIIA of improving cardiac dysfunction and fibrosis in MI rats and Ang II­treated CFs. These results demonstrated that TIIA improved cardiac dysfunction and fibrosis via inhibiting oxidative stress in HF rats. Nox4 could regulate the inhibitory effects of TIIA on HF and cardiac fibrosis.

[Effect of acupuncture on diaphragmatic function in patients with AECOPD typeâ ¡ respiratory failure evaluated by ultrasound detection].

OBJECTIVE: To observe the therapeutic effect of acupuncture combined with western conventional therapy on type Ⅱ respiratory failure of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and evaluate the effect of acupuncture on diaphragmatic function and prognosis by bedside ultrasound. METHODS: A total of 111 patients with AECOPD type Ⅱ respiratory failure were randomized into an acupuncture group, a conventional treatment group and a non-acupoint acupuncture group, 37 cases in each one. The routine AECOPD nursing care and treatment with western medicine were provided in the 3 groups. Additionally, in the acupuncture group, acupuncture was applied at Dingchuan (EX-B 1), Feishu (BL 13), Taiyuan (LU 9), Danzhong (CV 17) and Zhongwan (CV 12), etc. In the non-acupoint acupuncture group, acupuncture was given at the points 5 to 10 mm lateral to each of the acupoints selected in the acupuncture group. Acupuncture was given once every day, 30 min each time, consecutively for 10 days in the above two groups. Separately, before treatment, on day 3, 7 and 10 of treatment, arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and diaphragm thickening fraction (TFdi) were observed in each group. Before and after treatment, the inflammatory and immune indexes (levels of white blood cell [WBC], procalcitonin [PCT], hypersensitive C-reactive protein [hs-CRP] and T lymphocyte percentage [ %]), auxiliary respiratory muscle movement score, the score of chronic obstructive pulmonary disease (COPD) assessment test (CAT), the score of the modified British Medical Research Council dyspnea scale (mMRC) and the TCM syndrome score were compared in each group. The duration of mechanical ventilation, relative complications, 14-day clinical controlled discharge rate and the therapeutic effect were observed in each group. RESULTS: On day 3, 7 and 10 of treatment, PaO2 and TFdi were all increased as compared with those before treatment (P<0.01) and PaCO2 was reduced as compared with that before treatment in each group (P<0.01). After treatment, % was increased as compared with that before treatment in each group (P<0.01), WBC, PCT, hs-CRP, auxiliary respiratory muscle movement score, CAT score, mMRC score and TCM syndrome score were all reduced as compared with those before treatment in each group (P<0.01). After treatment, PaCO2, WBC, PCT, hs-CRP, auxiliary respiratory muscle movement score, CAT score and mMRC score in the acupuncture group were all lower than the other two groups (P<0.01), PaO2 and TFdi were higher than the other two groups (P<0.01); % was higher and TCM syndrome score was lower in the acupuncture group compared with those in the non-acupoint acupuncture group (P<0.01). The duration of mechanical ventilation and the total incidence of complications in the acupuncture group were all lower than the other two groups (P<0.01), and the 14-day clinical controlled discharge rate and total clinical effective rate were higher than the other two groups (P<0.01). CONCLUSION: Acupuncture as adjunctive therapy achieves significant therapeutic effect on AECOPD type Ⅱ respiratory failure. It improves diaphragmatic function, promotes oxygenation and relieves carbon dioxide retention of artery, alleviates clinical symptoms and reduces the time of mechanic ventilation and hospitalization. Besides, the bedside ultrasound detection can objectively reflect the effect of acupuncture on diaphragmatic function in the patients with AECOPD complicated with typeⅡrespiratory failure.

Harpagide alleviate neuronal apoptosis and blood-brain barrier leakage by inhibiting TLR4/MyD88/NF-κB signaling pathway in Angiotensin II-induced microglial activation in vitro.

Angiotensin II, the effector peptide of the renin-angiotensin system, is not only a pivotal peptide implicated in the regulation of blood pressure but also a key mediator of the inflammatory processes that play an important role in the pathology of hypertension-related cSVD. Harpagide is the major bioactive constituent of Scrophulariae Radix widely used in traditional Chinese medicine for numerous diseases including hypertension. The present study aimed to investigate the effect of harpagide on Ang II-induced neuroinflammation and the potential mechanism. Pretreated with harpagide or resatorvid (the TLR4 pathway inhibitor), BV2 cells were treated with Ang II or LPS (the TLR4 activator). NO, pro-inflammatory cytokines, the proteins on TLR4/MyD88/NF-κB signaling pathway and the expression of CD86, CD206, TREM2 in BV2 cells were detected respectively. Subsequently, the effects of harpagide on neurotoxicity and BBB destruction triggered by Ang II-induced neuroinflammation were investigated in the co-cultures of BV2 microglia/HT22 hippocampal neurons, BV2 microglia/bEnd.3 endotheliocyte and BV2 microglia/BBB monolayer model. We found that Ang II converted microglia into M1 state and resulted in neuroinflammation through activating TLR4/MyD88/NF-κB signaling pathway. It also triggered the imbalance of TLR4/TREM2 in microglia. Ang II-mediated inflammation microglia further led to neuronal apoptosis and BBB damage. Harpagide showed the effect of alleviating Ang II-mediated neuroinflammation as well as the resulting neurotoxicity and BBB destruction through inhibiting the TLR4/MyD88/NF-κB pathway. The anti-inflammatory and neuroprotective effect of harpagide suggested that it might be a potential therapeutic strategy in hypertensive cSVD.

[Combined predictive value of the risk factors influencing the short-term prognosis of sepsis].

OBJECTIVE: To explore the risk factors influencing the short-term mortality of patients with sepsis in intensive care unit (ICU) and the combined value of predicting prognosis. METHODS: A retrospective analysis was performed on 104 patients with sepsis admitted to emergency ICU of Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2018 to August 2019. Multiple general information containing gender, age, past history as well as complications and sequential organ failure assessment (SOFA) score, mean arterial pressure (MAP), blood routine examination, hepatic and renal function, coagulation indicators and procalcitonin (PCT) were collected within 24 hours of admission. Patients were divided into death group and survival group according to the 28-day outcome. Univariate and multivariate Logistic regression analysis were used to find the effective factors influencing the prognosis of sepsis. Receiver operating characteristic (ROC) curve was drawn to evaluate the value of related indexes in predicting the prognosis of sepsis. Correlation between parameters that might be relevant to disease severity and SOFA score was evaluated by Pearson or Spearman correlation analysis. RESULTS: 104 patients were enrolled for final analysis, of whom 60 patients survived, while the others died with a 28-day mortality of 42.3%. (1) Univariate analysis results: the incidence of acute kidney injury (AKI), SOFA score, serum creatinine (SCr), D-dimer, activated partial thromboplastin time (APTT), international normalized ratio (INR) and PCT in the death group were significantly higher than those in the survival group [incidence of AKI: 70.5% (31/44) vs. 36.7% (22/60), SOFA score: 11.0 (8.0, 13.0) vs. 8.0 (6.2, 10.0), SCr (µmol/L): 108.8 (65.5, 235.6) vs. 75.1 (55.1, 109.5), D-dimer (mg/L): 4.1 (1.6, 11.6) vs. 2.1 (1.2, 4.3), APTT (s): 42.6 (37.7, 55.7) vs. 40.3 (35.9, 44.7), INR: 1.3 (1.2, 1.5) vs. 1.2 (1.1, 1.4), PCT (µg/L): 3.1 (0.4, 39.9) vs. 0.3 (0.1, 3.4), all P < 0.05]. (2) Multivariate Logistic regression analysis results: all indicators of univariate analysis were included in the multivariate Logistic regression model considering interaction between each variable. Multivariate Logistic regression analysis was repeated based on conditional backward method. Age, SOFA score, MAP, neutrophil (NEU), lymphocyte (LYM) and APTT were automatically selected by SPSS software to build the predicting model. Analysis results showed that SOFA score, NEU and LYM were independent risk factors for the short-term prognosis of sepsis [SOFA score: odds ratio (OR) = 1.22, 95% confidence interval (95%CI) was 1.04-1.44, P = 0.02; NEU: OR = 1.14, 95%CI was 1.03-1.26, P = 0.01; LYM: OR = 0.79, 95%CI was 0.66-0.95, P = 0.01]. (3) ROC curve analysis results: the above six-variable prediction model had the optimal fitting degree defaulted by SPSS. ROC curve showed that the combination of age [area under ROC curve (AUC) = 0.60], SOFA score (AUC = 0.71), MAP (AUC = 0.53), NEU (AUC = 0.59), LYM (AUC = 0.54) and APTT (AUC = 0.61) had better sensitivity (79.5%) and specificity (65.0%) as well as the maximal AUC (AUC = 0.75), which suggested that combined prediction had higher diagnostic value in predicting the short-term prognosis of sepsis. (4) Correlation analysis showed that NEU, D-dimer, prothrombin time (PT), APTT, INR and PCT were positively correlated with SOFA score (r values were 0.26, 0.28, 0.21, 0.22, 0.10, 0.38, respectively, all P < 0.05). CONCLUSIONS: SOFA score, NEU and LYM were independent risk factors for the short-term prognosis of sepsis. The combination of age, SOFA score, MAP, NEU, LYM and APTT were more accurate than any single factor in predicting the short-term prognosis of sepsis and had higher diagnostic value. NEU, D-dimer, PT, APTT, INR and PCT were correlated with SOFA score.

Shenfu injection attenuates lipopolysaccharide-induced myocardial inflammation and apoptosis in rats.

Shenfu injection (SFI), a Chinese medicinal product, shows potent efficacy in treating sepsis. The aim of the present study was to clarify the protective effects of SFI against lipopolysaccharide (LPS)-induced myocardial inflammation and apoptosis. Experiments were carried out in Sprague-Dawley (SD) rats treated with LPS or LPS + SFI, and in H9C2 cardiomyocytes. The sepsis-associated myocardial inflammation and apoptosis was induced by the intraperitoneal injection of LPS (20 mg·kg-1). SFI attenuated the increased expression of tumor necrosis factor (TNF)-α and interleukin (IL)-1ß induced by LPS both in serum and heart. In LPS group, cell viability was reduced, and reversed after SFI administration. LPS treatment increased the expression levels of cleaved-caspase 3 and Bax, and those of Bcl2 and Bcl2/Bax. These two trends were reversed by SFI administration. The expression levels of phosphorylated mitogen-activated protein kinase kinase (p-MEK) and phosphorylated extracellular regulated protein kinases (p-ERK) were increased by LPS, and reversed by SFI. MEK inhibitor U0126 attenuated the apoptosis induced by LPS. These results indicate that SFI could treat LPS-induced cardiac dysfunction. In conclusion, SFI attenuates the inflammation and apoptosis induced by LPS via downregulating the MEK and ERK signaling pathways.

miR-205 as a biological marker in non-small cell lung cancer.

OBJECTION: The aim of this study is to explain the significance and mechanism of miR-205 in the diagnosis and treatment of non-small cell lung cancer. METHODS: The 70 advanced NSCLC patients, treated in our hospital, were collected from 2011.10 to 2013.9, taking the tissues from cancer and adjacent tissues to measure the miR-205 expression, evaluate the AKT gene and protein expression of cancer and adjacent normal tissues by RT-PCR and Immunohistochemistry (IHC) assays and analyzing the correlation between miR-205 and AKT. Following up the patients for 2 years; Recording patients' survival time. In the cell experiment, Selecting A549 cell as research object, the cells were divided into three groups: Normal control group (NC), Blank control group (BL) and si-miR-205 transfection group (si-miR-205). Cell proliferation rate and apoptosis rate were detected by MTT method and flow cytometry; Measuring invasion and migration of difference groups by transwell and scratch testing, measured the Akt, mTOR,P21, MMP2 and MMP9 gene expression and detected Akt, p-Akt, mTOR, p-mTOR, P21, MMP2 and MMP 9 protein expression levels. RESULTS: Compared with adjacent normal tissue, the miR-205 and AKT gene expression level was significantly increased in NSCLC tissues (P<0.05) and the AKT protein expression was stronger than that of healthy tissues, miR-205 was positive correlation with AKT; In the overall survival, MiR-205 high expression group was significantly higher than low expression group (P<0.05). In the cell experiment, Compared with NC and BL groups, si-miR-205 could significantly reduced the biological activity of A549 cells in proliferation, invasion and migration, and promoted the apoptosis of A549 cells (P<0.05, respectively). Akt, p-Akt, mTOR, p-mTOR, P21, MMP 2 and MMP 9 gene and protein expression of si-miR-205 group were significantly compared with NC and BL groups (P<0.05, respectively). CONCLUSION: miRNA-205 might serve as a potential biomarker for the prognosis of advanced NSCLC, and inhibiting miR-205 expression could decrease A549 cells biological activity by regulating Akt/mTOR/P21 and Akt/MMP 2/MMP 9signaling pathway.