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Summary Given the lack of defining features in the clinical manifestations and radiographic findings for children with mycoplasma pneumoniae pneumonia (MPP), quantitative polymerase chain reaction (qPCR) has become a useful diagnostic method. This study was performed to explore the relationship between the qPCR findings, clinical symptoms, and inflammatory markers in children with MPP. Four hundred children with MPP have been enrolled in this retrospective analysis. All clinical and analytical information, including mycoplasma pneumoniae (MP) PCR results, has been collected. Based on the PCR results, the patients were divided into groups with load values (copy number) < 105 (54 cases), ≥105 and 108 (49 cases). The clinical features (including symptoms and signs) and inflammatory indicators were compared among the groups. The incidence of high fever (above 39°C), thermal peak during the entire hospitalization period, fever duration, days of hospitalization, and plasma lactate dehydrogenase (LDH) levels were statistically correlated with the MP PCR load value in children with MPP. The analysis of relevance degree showed the correlative order as a thermal peak of hospitalization > duration of fever > period of hospitalization > LDH value > C-reactive protein value. The host immune response was significantly greater in the complication group than in the non-complication group.

Background The aim of this study was to explore the potential mechanism of circular RNA (circRNA) CirCHIPK3 on the malignant proliferation and metastasis of breast cancer (BC). Methods Human BC samples and their matched normal adjacent tissues were obtained from 50 patients to assess the expression of CirCHIPK3 and its relationship with BC prognosis. A series of in vitro and in vivo functional experiments were carried out to elucidate the role of CirCHIPK3 in BC progression and its underlying molecular mechanisms. Moreover, the interaction of CirCHIPK3, miR-193a, and HMGB1 was examined using bioinformatics, FISH, RIP, RNA-pull down and luciferase reporter assays. Western blot analysis was performed to examine the expression of HMGB1, p-PI3K, total PI3K, p-AKT, and AKT after si-CirCHIPK3 transfection. Results Upregulation of CirCHIPK3 was identified in BC, which predicted a worse prognosis in BC patients. Furthermore, it was found that CirCHIPK3 facilitated cell proliferation, migration, and invasion in BC by regulating miR-193a/HMGB1/PI3K/AKT signaling. CirCHIPK3 acted as a sponge for miR-193a to facilitate HMGB1 expression. si-CirCHIPK3 also inhibited tumor growth of BC in nude mice. si-CircCHIPK3 decreased HMGB1/PI3K/AKT signal expression in MDA-MB-231 cells, whereas overexpression of CircCHIPK3 enhanced HMGB1/PI3K/AKT signal. Conclusions CirCHIPK3 regulated miR-193a/HMGB1/PI3K/AKT signaling to facilitate BC development and progression, providing a novel therapeutic target for BC.

Background Traditional Chinese medicine (TCM) plays an important role in contributing to the public health in China. However, non-standardized outcomes in TCM related studies posed great difficulty in data synthesis for healthcare decisions. An agreed set of standardized outcomes, or termed as a core outcome set (COS), can solve this existing problem of outcome heterogeneity. This review aimed to analyze outcome heterogeneity, assess the quality of outcome reporting and providing a list of potential outcomes for COS development of SAP using TCM. Methods 8 literature databases were searched to identify clinical studies about TCM for SAP (SAP-TCM) of yearly samples of 2005, 2010, 2015, 2016, 2018 and 2019. 2 clinical registry databases were searched from inception to October 2020. Outcomes definition, measurement methods and time-point were extracted and categorized into 7 themes which include clinical symptoms and signs, physical and chemical examination, TCM-related outcomes, adverse events, quality of life, long-term prognosis and economic evaluation. Timing and quality assessment of the outcomes reported were analyzed and evaluated. Results A total of 1166 studies were included from 12962 potential studies, involving 111426 patients. 231 outcomes were identified and a total of 89 outcomes reported at least twice in the studies. The most commonly reported theme was clinical symptoms and signs. The most frequently reported outcomes were total rate of ECG efficiency and angina attack in clinical studies of published literature and clinical registries databases respectively. Outcomes reported in a single study ranged from 1 to 15, and 5 outcomes on average per study. 80% of the studies lack reporting of primary outcomes. A wide variation of measurement instruments or methods was used. A range of 1–17 measurement time-points were recorded. Quality assessment of outcome reporting was generally low, with 65.6% of the studies scoring 3 to 4 points. Conclusion Outcomes reported in studies on SAP-TCM are heterogeneous. A lack of standardization complicates comparisons of outcomes across studies. Developing a COS for SAP-TCM could contribute to the standardization of outcome reporting and offer a stronger evidence for health decision-making.

The Dielectric Barrier Discharge plasma (DBD) plasma was used to treat Diisopropyl fluorophosphate (DFP, a stimulant of sarin) in the air. The influence factors of degradation efficiency, including power, carrier gas flow velocity and initial concentration of DFP were investigated. As a result, the degradation efficiency increased with the power increasing. The degradation efficiency increased fastly when the power less than 105W, but slowly when the power more than 105W. The degradation efficiency decreased obviously with the carrier gas flow velocity increasing, because the time of DFP stayed in plasma reactor decreased and the concentration of DFP increased. The degradation efficiency rose firstly and then fell with the initial DFP increasing, when the initial concentration was less than 80 mg/m3, but decreased with the the initial concentration increasing, when the initial concentration was more than 80 mg/m3. The main products were acetone, isopropanol, phosphoric acid, pyrophosphoric acid, carbon dioxide and water, analyzed by GC-MS. Reaction mechanism was discussed according to degradation products.

Background The prone position (PP) improves ventilation homogeneity in acute respiratory distress syndrome. The aim of this study was to investigate whether the alleviation of ventilation inhomogeneity in PP was due to changes in regional lung compliance. Methods Ten lung-lavaged piglets were mechanically ventilated in supine position (SP) and in PP. In each position, positive end-expiratory pressure (PEEP) was reduced from 20 to 6 cmH2O in steps of 2 cmH2O every 10 min after full lung recruitment. Respiratory mechanics, blood gas, haemodynamic data and whole-lung computed tomography scans were recorded at each PEEP. The compliances of normally aerated (C normal) and newly recruited (C recruited) lung regions were calculated. Open lung PEEP (OL-PEEP) was defined as the lowest PEEP to maintain full lung recruitment. Results At OL-PEEP, PP significantly increased normally aerated lung regions, decreased poorly aerated and hyperinflated lung regions and decreased tidal recruitment and hyperinflation. C normal was significantly reduced in PP compared with SP (12.8 ± 4.2 ml/cmH2O vs. 20.1 ± 6.2 ml/cmH2O, P

Recently, there is an increasing number of clinical trials on Traditional Chinese medicine (TCM) published, but the implementation of Clinical Trial Registration (CTR), Ethical Review (ER), and Informed Consent (IC) in clinical trials of TCM is unclear. This study aims to investigate the status of CTR, ER, and IC in clinical trials of TCM.Clinical trials of TCM published in 10 high-quality Chinese journals in 2016 were selected as a sample. Information of clinical trial registration, ethical review, and informed consent of clinical trials was extracted for analysis. Two authors independently screened the literature and extracted the relevant information.A total of 659 clinical trials met the criteria and were included for analysis. Only 9 clinical trials reported information of clinical trial registration (1.4%). The number for ethical review and informed consent were 156 (23.7%) and 502 (76.2%).Trial registration, protocol approval, and informed consent were not well executed. Especially registration and ethical review of clinical trials in TCM should be carefully concerned by researchers, clinicians, and journal editors. Training on methodology of clinical trial should be strengthened.

Objective: The purpose of this retrospective study was to evaluate the clinical value of serum cytokeratin-19-fragment (cyfra21-1) as a biomarker in nonsmall cell lung cancer (NSCLC). Methods: Sixty-six patients with NSCLC and 48 cases with benign lung disease were retrospectively analyzed in the department of thoracic surgery in our hospital. The serum level of cyfra21-1 was detected in the above patients. The diagnosis sensitivity, specificity and the receiver operating characteristic curve were calculated by using the stata11.0 statistical software to evaluate the clinical diagnosis value of serum Cyfra21-1 as NSCLC serologic biomarker. Results: The mean of serum cyfra21-1 were 8.95 eat. 01 μ/L and 4.28 eat. 89 μ/L in NSCLC patient and control groups respectively, which indicated that the NSCLC group were much higher (P < 0.05). The diagnosis sensitivity and specificity were 77.08% and 63.64% at the threshold of 6.32 μ/L respectively. Moreover, the area under the curve was 0.78 (95% confidence interval: 0.70-0.87). Conclusion: Serum cyfra21-1 can be a potential serologic biomarker in evaluation of NSCLC.

Background: In the acute respiratory distress syndrome (ARDS), lung-protective ventilation strategies combine the delivery of small tidal volumes (VT) with sufficient positive end-expiratory pressure (PEEP). However, an optimal approach guiding the setting of PEEP has not been defined. Monitoring volumetric capnography is useful to detect changes in lung aeration. Objectives: The aim of this study was to determine whether volumetric capnography may be a useful method to determine the optimal PEEP in ARDS. Methods: In 8 lung-lavaged piglets, PEEP was reduced from 20 to 4 cm H2O in steps of 4 cm H2O every 10 min followed by full lung recruitment. Volumetric capnography, respiratory mechanics, blood gas analysis, hemodynamic data and whole-lung computed tomography scans were obtained at each PEEP level. Results: After lung recruitment, end-expiratory lung volume progressively decreased from 1,160 ± 273 ml at PEEP 20 cm H2O to 314 ± 86 ml at PEEP 4 cm H2O. The ratio of alveolar dead space (VDalv) to alveolar VT (VTalv) and the phase III slope of volumetric capnography (SIII) reached a minimum at PEEP 16 cm H2O. At this PEEP level, overaerated lung regions were significantly reduced, nonaerated lung regions did not increase, and partial pressure of oxygen in arterial blood/fraction of inspired oxygen (P/F) and static respiratory system compliance (Crs) reached a maximum. At PEEP levels 2O, nonaerated lung regions significantly increased, P/F and Crs deteriorated, and VDalv/VTalv and SIII began to increase. Conclusions: In this surfactant-depleted model, PEEP at the lowest VDalv/VTalv and SIII allows an optimal balance between lung overinflation and collapse. Hence, volumetric capnography is a useful bedside approach to identify the optimal PEEP.

The accuracy of end-expiratory lung volume measurement by the modified nitrogen wash-out/wash-in method (EELV-N(2)) depends on the precise determination of carbon dioxide elimination (V(CO(2))), which is affected by alveolar dead space (V(D-alv)). The purpose of this study was to investigate the influence of V(D-alv) on EELV-N(2).Six piglets with lavage-induced acute lung injury were mechanically ventilated in a decremental PEEP trial that was reduced from 20 to 4 cm H(2)O in steps of 4 cm H(2)O every 10 min. EELV was measured by the modified EELV-N(2) method and computed tomography scan (EELV-CT), volumetric capnography, blood gas measurements, and hemodynamic data were recorded at each PEEP level. The data were divided into higher and lower PEEP groups.During the decremental PEEP trial, EELV-N(2) exhibited a high correlation (r(2) = 0.86, P.001) with EELV-CT, with a bias of -48.6 ± 150.7 mL (1 ± 18%). In the higher PEEP group, EELV-N(2) was not correlated with EELV-CT, with a bias of -168.1 ± 171.5 mL (-14 ± 14%). However, in the lower PEEP group, EELV-N(2) exhibited a high correlation (r(2) = 0.86, P.001) with EELV-CT, with a bias of 11.2 ± 97.2 mL (6 ± 17%). The measurement bias was negatively correlated with V(D-alv) (r(2) = 0.44, P = .04) and V(CO(2)) (r(2) = 0.47, P = .03) in the higher PEEP group.In this surfactant-depleted model, EELV measurement by the modified EELV-N(2) method reveals a systematic underestimation at high PEEP levels that is partly due to an increase in V(D-alv).

The differentiation of mesenchymal stem cells (MSCs) into type II alveolar epithelial (AT II) cells in vivo and in vitro, is critical for reepithelization and recovery in acute lung injury (ALI), but the mechanisms responsible for differentiation are unclear. In the present study, we investigated the role of the canonical wnt pathway in the differentiation of mouse bone marrow-derived MSCs (mMSCs) into AT II cells. Using a modified co-culture system with murine lung epithelial-12 (MLE-12) cells and small airway growth media (SAGM) to efficiently drive mMSCs differentiation, we found that GSK 3β and β-catenin in the canonical wnt pathway were up-regulated during differentiation. The levels of surfactant protein (SP) C, SPB, and SPD, the specific markers of AT II cells, correspondingly increased in mMSCs when Wnt3a or LiCl was added to the co-culture system to activate wnt/β-catenin signaling. The expression of these factors was depressed to some extent by inhibiting the pathway with the addition of DKK 1. The differentiation rate of mMSCs also depends on their abilities to accumulate and survive in inflammatory tissue. Our results suggested that the activation of wnt/β-catenin signaling promoted mMSCs migration towards ALI mouse-derived lung tissue in a Transwell assay, and ameliorated the cell death and the reduction of Bcl-2/Bax induced by H(2) O(2), which simultaneously caused reduced GSK 3β and β-catenin in mMSCs. These data supports a potential mechanism for the differentiation of mMSCs into AT II cells involving canonical wnt pathway activation, which may be significant to their application in ALI.